Back to School: Part 2 – What Parents Need to Know about Childhood Vaccinations

The list of diseases that are preventable with vaccines is a long one. It includes polio, whooping cough, typhoid fever, measles, diphtheria and tetanus, among many others. These diseases have been mostly eliminated in the U.S., thanks to the development of highly effective vaccines over the past 70 years. 

The question on many parents’ minds is: Are vaccines safe? The short answer is “yes.” Says Dr. David Laufgraben, an Assistant Attending Pediatrician and Assistant Professor of Clinical Pediatrics at Weill Cornell Medicine, every vaccine is the product of years of research and strictly run clinical trials that establish their safety and efficacy. And even long after they’re approved by the Food and Drug Administration (FDA), they continue to be closely monitored.” 

What’s more, he says, serious side effects are extremely rare. The common vaccine side effects are minor, such as fever, fussiness or redness at the injection site. “These typically go away within one or two days,” he says. “But for a few vaccines, such as chicken pox, a child can have a delayed reaction with the appearance of a rash and fever a few weeks later. That kind of mild reaction shows that your child’s immune system is functioning the way we expect it to.” 

Read on for answers to your FAQs—and for all the information you need about the vaccines your child is required to receive before the first day of school. 

Why are vaccines needed for diseases we don’t see much of anymore? 

Serious childhood diseases used to be a lot more common. Hospital beds were filled with children paralyzed by polio or wracked with whooping cough, a disease known as the hundred-day cough for its persistent respiratory symptoms that could even be fatal, Dr. Laufgraben says.  

Although the diseases vaccines prevent are far less common today, they aren’t gone. Here in New York City, we were reminded of that stark fact when a dip in vaccination rates led to an outbreak of measles in 2019. 

Some pediatricians liken childhood vaccinations to making sure your child wears a seatbelt. “None of us expect to get in a car accident, just as nobody expects their child to catch polio, measles or whooping cough. But accidents can still happen, and vaccines, like seatbelts, help to protect your child from the unexpected,” says Dr. Laufgraben. “And when you vaccinate your child, you also protect all the people around them, including kids and adults with cancer or rare immune disorders who may not even be allowed to get vaccinated.” 

Will giving babies multiple vaccines at the same time overload their immune systems? 

Getting multiple vaccines during one visit is absolutely safe, he says. They boost the immune system; they don’t overwhelm it.  

“Our immune systems encounter way more germs in our day-to-day lives than we are ever exposed to by getting vaccinated. When we administer several vaccines at the same time, it allows us to protect kids from more diseases at the earliest possible age.” 

Why are multiple doses necessary? 

Our goal, he says, is to have protection that lasts. For some vaccines, we need multiple doses to boost their efficacy. Hence, the term “booster.” Vaccine boosters are given to counter the tendency of vaccine efficacy to wane over time. 

Is there any truth to the idea that vaccines cause autism or SIDS? 

The putative link between vaccines and autism has been exhaustively researched, says Dr. Laufgraben. The records of millions of kids from all over the world have been systematically studied, and there is no evidence of a link between autism and vaccines.  

The actual causes of autism, and the best ways to support kids on the autism spectrum, will continue to be subjected to the most strenuous research efforts. But based on the huge amount of evidence gathered thus far, vaccines do not cause autism. 

The same holds true for SIDS (sudden infant death syndrome). There is no evidence linking SIDS to vaccines, he says. “In the early 2000s, the child vaccination rate increased, but the SIDS rate stayed low—one more assurance that vaccination does not cause SIDS.” 

Why does my child need to be vaccinated against chickenpox? Isn’t chickenpox just a mild childhood disease?  

That’s true: it used to be nearly universal for children to catch chickenpox—a highly contagious disease—and for most cases to be mild. But chickenpox can have complications, such as skin infections, pneumonia, meningitis and even, rarely, death. Before the varicella vaccine became available in the mid-1990s, thousands of kids were hospitalized with severe chickenpox.  

If more children were unvaccinated, there would be more chickenpox in circulation. We’d lose herd immunity to that disease. And people at high risk of complications, such as cancer patients and pregnant women, could become infected.  

“Since the vaccine was introduced, chickenpox cases have fallen by more than 95 percent, but that progress could be reversed if vaccination rates fall,” he says. 

Can I delay or skip some vaccines? Is it safe to follow an “alternative” schedule? 

The risk of not taking the right doses of a vaccine at the right time is a real one. For instance, says Dr. Laufgraben, “kids can still catch whooping cough. They can become very sick from that disease. And when vaccination rates in a community fall, we lose ‘herd immunity.’ Let me explain that term. 

“If the vast majority in that community have been vaccinated, it’s unlikely for the disease in question to spread,” he continues. “But the more people in a group who choose not to get vaccinated, the easier it becomes for diseases, even rare ones, to spread. That’s exactly what happened with the 2019 measles outbreak in New York City.  

Which vaccines are required by New York City schools and child care programs?

New York City’s Department of Health has specified the following immunization guidelines: 

Students in child care through grade 12 must meet the requirements for: 

  • the Dtap (diphtheria-tetanus-pertussis), polio, MMR (measles-mumps-rubella), varicella (chickenpox) and hepatitis B vaccines 

Children under age 5 who are enrolled in child care or pre-K must meet the requirements for: 

  • the Hib (Haemophilus influenza type b) and PCV (pneumococcal conjugate) vaccines 
  • the flu vaccine (when it becomes available in the early fall) 

Children in grades 6 through 12 are required to receive: 

  • the Tdap (tetanus-diphtheria-pertussis) booster and MenACWY (meningococcal conjugate) vaccines. 

See here for guidance provided for parents by New York City’s public schools on detailed information about child immunization requirements, including medical exemptions. As of June 2019, New York State no longer allows religious exemptions from mandated vaccinations. 

Make an appointment with your pediatrician before the start of the new school year here.