When parents choose not to vaccinate Risks & Responsibilities

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Protecting your child

Parents are responsible for their child’s health and well-being, including protecting them from vaccine-preventable diseases.If you choose not to vaccinate your child you should understand the risks. You need to know how to make it less likely that your child gets an infection or spreads disease to others.

Infant and childhood vaccines prevent diseases that can be serious and even deadly. Some examples:

Measles can cause brain swelling, which can lead to brain damage or death.
Mumps can cause permanent deafness.
Meningitis can also lead to permanent deafness or brain damage.
Polio can cause permanent paralysis.

Any child can be exposed to these infections. While avoiding contact with sick people is useful, infections like measles can also spread through the air. Your child may come in contact with people are carrying germs, even if they don’t seem sick.

There are no treatments or cures for diseases like measles, mumps and polio. The only proven way to protect your child is with vaccines.

Delaying or refusing some or all vaccines for your child puts his health and life at risk. It also risks the health of other people. Those most at risk include:

People with weakened immune systems due to other diseases or medications they are taking.
People with chronic medical conditions like lung, heart, liver, kidney disease or diabetes.
Newborn babies, who are too young to be vaccinated against most diseases.
The elderly, who may be at higher risk of complications from diseases.

Communities depend on high immunization rates to keep vaccine-preventable diseases from spreading. When more people are immunized, there is less risk for everyone. The more parents that choose to not vaccinate their children, the greater the risk that infection will spread in the community.

If you choose not to fully vaccinate your child, follow these steps:

If your child is sick and you call or visit a health care provider, immediately tell office staff and the doctor that your child is not vaccinated (whether for some or all vaccines). They will consider the possibility that your child has a vaccine-preventable disease, which may affect what tests they do. If your child has a vaccine-preventable disease, precautions can be taken so that the disease does not spread to others.
Always keep vaccine records accessible so that you can report which vaccines your child has received, if any.

You choose not to vaccinate your child, and a vaccine-preventable disease is active in your community

Consider changing your mind and protecting your child with a vaccine. Talk to your child’s doctor or to someone at a public health clinic.
Your child may be asked to stay away from school, child care or other organized activities. You will be advised when it is safe for your child to return. Be prepared to keep your child home for up to several weeks.
Learn about the disease and how it spreads, although it may be impossible to avoid exposure.
Each disease is different. The time between when your child may have been exposed and when he may get sick will vary. Talk to your child’s doctor to find out when your child is no longer at risk of coming down with the disease.
If you know that your child has been exposed to a vaccine-preventable disease, learn what symptoms to look for and get urgent medical care if these develop.
Follow recommendations to separate your child from others, including family members – especially newborn babies, the elderly and people with weakened immune systems or chronic diseases.

• Tetanus (also called lockjaw) is a serious disease caused by germs found in the soil. There is no “community protection” against tetanus. It does not spread from child to child. If your child is not vaccinated against tetanus, he is at risk. • Even a minor cut or wound that has a tiny bit of soil in it can cause an infection. Over 10% of children and adults who get tetanus will die, even with the best intensive care. • Over half of those who get tetanus have no history of a major cut or injury, so if your child becomes sick, make sure the doctor knows right away that she is not vaccinated. If your child has not received at least 3 doses of tetanus vaccine and has a major cut or injury, she should be given a special blood product called “tetanus immune globulin” as soon as possible to prevent tetanus.

• When travelling to another country, you and your family may be at risk for vaccine-preventable diseases. These may include diseases for which vaccines are not routinely given in Canada. • Learn about possible infection risks where you’re going. In many countries, vaccination rates are lower than in Canada. This means you may be exposed to infections that are rare in Canada. • If your child gets sick, she may not receive the same quality medical care she would get at home. Consider having your child vaccinated before travelling to such countries. • Children with vaccine-preventable diseases may be refused permission to travel by public transport (air, train or bus).

Vaccines: Myths and Facts

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Immunization is one of the most important ways to keep your child healthy. Vaccines are very safe. There are rarely reasons to not get vaccinated. Below are some common myths and facts about vaccines.

MYTH: Most diseases are not serious.
FACT: All of the diseases that children are vaccinated against are serious.

They can all cause serious illness, complications and death, even with the best medical care. Many of these diseases also have no cure.
• Measles outbreaks still happen. Complications occur in about 10% of cases. For every 1,000 cases of measles, 1 or 2 of those people will die.
• Pertussis (whooping cough) kills between 1 and 4 babies in Canada every year. About 1 in 400 babies who survive pertussis has permanent brain damage.
• Tetanus kills 10% or more of its victims.

MYTH: My child doesn’t need vaccines because no one gets these diseases anymore.

FACT: These diseases still exist, even if they are rare. Thanks to vaccine programs, all vaccine-preventable diseases have declined in Canada. But when immunization rates drop, these diseases can come back.

Many of the vaccine-preventable diseases that are uncommon in Canada still occur in other parts of the world. With travel and immigration, there is a real risk of these diseases being brought into Canada. Any child who is not vaccinated is at risk when infections are “imported”.

MYTH: If so many other people are vaccinated, my child doesn’t need vaccines.

FACT: Yes, they do. Relying on actions of other parents to protect your unvaccinated child only works if everyone else is vaccinated. If many parents take this attitude, fewer children will be immunized and diseases will start to spread quickly.

And when it comes to tetanus, whether other people are vaccinated makes no difference to your child’s safety. Tetanus is caused when bacteria from the soil get into a wound.

MYTH: It’s better to get vaccines one at a time.

FACT: Thanks to combination vaccines, your child can get protection from many different diseases with one injection (shot). Examples include MMR (measles, mumps, rubella) and the 5-in-1 vaccine (diphtheria, tetanus, pertussis, polio, Hib disease). Studies show that combination vaccines are safe and effective. There is no reason for your child to get the vaccines one at a time. Getting more than one vaccine at once also means no delay in protection, fewer medical visits and fewer needles (which can be less traumatic).

MYTH: There will be fewer side effects if I delay my baby’s vaccinations.

FACT: Vaccines begin at 2 months of age to protect babies as early in life as possible against diseases that can make them very sick (such as pertussis). Babies respond well to vaccines at a very young age. Side effects from vaccination are not more common in young babies than older children.

MYTH: Vaccines are not adequately tested for safety.

FACT: Vaccines are safe & effective. Vaccines must prove to be safe and effective at preventing the diseases they target. Once a vaccine is in use, Canadian health authorities continue to monitor for side effects. Serious side effects to vaccines are very rare.

MYTH: The MMR vaccine causes autism.

FACT: No, the MMR vaccine does not cause autism. There is no scientific evidence to support this claim. Because signs of autism may appear around the same age that children receive the MMR vaccine, some people believe the vaccine causes the condition.

Much of the controversy over the MMR vaccine and autism came from a single paper published in 1998 that suggested a link. The report has been found to be fraudulent, and was withdrawn by the journal that published it. Many large scientific studies around the world have found no link between the MMR vaccine and autism.

There is no evidence to link any other vaccines to autism. The number of children with autism seems to have increased in recent years. This is because the diagnosis of autism now includes children with milder symptoms who would not have been included in the past. There is also greater public awareness of autism, and more parents are seeking help. Scientists recently found a gene linked to autism.

MYTH: Thimerosal in vaccines causes autism.

FACT: There is no evidence linking thimerosal (a preservative once used in vaccines) to autism or any other developmental disorder. Also, thimerosal has not been used in infant and childhood vaccines for many years. Yet the numbers of children with autism continued to increase, even after thimerosal stopped being used in vaccines.

Myth: I’m breastfeeding, so my baby is protected from infections.

FACT: Breastfeeding is not a substitute for vaccination. Breastfeeding provides some protection against certain infections, especially viral respiratory infections, ear infections and diarrhea. But this protection is incomplete, temporary, and can be overcome if your baby is exposed to large amounts of a specific germ.

Myth: Natural is better. We shouldn’t put foreign substances like vaccines into our bodies.

FACT: Natural is not always better. The germs that vaccines protect against are part of nature, but they are harmful. Many things in nature should not be ingested: Some of the most powerful poisons come from plants and berries. Vaccines are made from natural sources. Some vaccines are made from live germs that have undergone changes so they can’t cause illness. Others contain only part of the germ that has been pulled out and purified. Vaccines stimulate our immune system the same way the infection would, but without making us sick.

Myth: Nosodes are safer and a good alternative to vaccines.

FACT: Nosodes are not a good substitute for vaccines and there is no scientific or medical evidence to show they prevent infectious diseases. Nosodes are made using bacteria, viruses, tissue or other material from someone with a particular infection or disease. The substance is then diluted so much that little or no active ingredients are left in the final product. Although they are often called “homeopathic vaccines,” they are not the same as getting immunized.

Vaccines: Common concerns

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Many parents and caregivers have concerns about vaccines. Some are scared that vaccines will harm their child. Others are not sure whether their child really needs all the vaccines being given. Parents may also feel confused byonline information and comments on social media But the risks associated with the vaccines children receive are much, much less than the risks associated with the diseases themselves.

Do vaccines really work?

Yes. All vaccine-preventable diseases have declined in countries with successful vaccination programs. When vaccination rates are high, disease rates are low. But, when vaccination rates start to go down (for example, when there is fear of vaccines, or health care is disrupted during a war or other disaster) disease and related deaths always go up.

Vaccines protect children who are immunized, and people close to them– like newborn babies too young to be vaccinated or others whose immune systems don’t work as well – by preventing the spread of disease.

No. Our immune system responds to very large numbers of antigens (proteins and complex sugars) that are found all around us every day. Vaccines only add a few antigens to these numbers.

Vaccines are safe & effective. Like all medicines, vaccines must go through many steps before Health Canada approves them for use. Vaccines must prove to be safe and effective at preventing the diseases they target. Once a vaccine is in use, Canadian health authorities continue to monitor for side effects. Serious side effects to vaccines are very rare.

The chance of getting sick from a vaccine-preventable disease is far greater than the very small risk of having a serious side effect from the vaccine itself.

Some children will have mild pain and redness – sometimes with a bit of swelling – where the needle went into the arm or leg. If necessary, acetaminophen (such as Tylenol, Tempra, Panadol and others) will help ease the pain.
A mild fever is common after vaccination. A high fever can happen in young infants, especially after the first dose of a vaccine. In a few cases, fever may cause a febrile seizure. Febrile seizures are NOT dangerous and don’t cause any brain damage. They happen more often in children whose parents or siblings have also had febrile seizures. They are also more likely to happen in children who already have epilepsy or a brain disorder.
Fever combined with a rash may happen after the MMR, MMRV or Varicella (Chicken Pox) vaccine.
Anxiety about needles may cause fainting, especially in older children and teens.

Other side effects, including serious allergic reactions, are very rare. Children who have had a serious allergic reaction to a previous dose of vaccine (swelling of the face or lips, difficulty breathing or a drop in blood pressure) should not get that vaccine again unless seen by a specialist or vaccinated in a special clinic that can control severe reactions.

Can measles vaccine or measles-mumps-rubella (MMR) vaccine cause autism or other developmental disorders?

No. There is no scientific evidence to support this claim. Because signs of autism may appear around the same age that children receive the MMR vaccine, some parents believe the vaccine causes the condition.
Much of the controversy over the MMR vaccine and autism came from a paper published in 1998 that suggested a link. But since then, the report has been found to be fraudulent and was withdrawn by the journal that published it. Many large scientific studies around the world have found no link between the MMR vaccine and autism.
Also, there is no evidence to link any other vaccines to autism. The number of children with autism seems to have increased in recent years. This is because the diagnosis of autism now includes children with milder symptoms who would not have been included in the past. There is also greater public awareness of autism, and more parents are seeking help. Scientists recently found a gene linked to autism.

Can the pertussis (“whooping cough”) vaccine cause brain damage? SIDS (sudden infant death syndrome)?

No. But, pertussis infection can cause seizures, brain damage and infant death.

No. Many large studies have found no link between vaccines and SIDS. In fact, some studies found that babies who died of SIDS were less likely to have been recently vaccinated than babies who did not die.

Can vaccines cause type 1 diabetes? asthma and other kinds of allergic disease or cancer?

There is no relationship between vaccines and type 1 diabetes. While the cause of type 1 diabetes is not known, there is evidence to suggest that viral infections may be important triggers for this disease in children.

No. Studies show that vaccination does not increase the number of asthma cases and other allergic diseases in children.

No. There is no evidence of a link between vaccines and cancer. In fact, two vaccines protect against cancer. Hepatitis B vaccine protects against cancer of the liver, and Human Papilloma Virus Vaccine protects against cancer of the cervix and some other genital cancers.

Can vaccines cause Crohn’s disease or colitis? multiple sclerosis (MS)?

No. There is no association between vaccines and Crohn’s disease or any other form of inflammatory bowel disease.
There is no evidence that vaccines cause MS or even flare-ups in a person with MS. In particular, hepatitis B and influenza (flu) vaccines have been shown to have no effect on symptoms or on the speed that symptoms progress in patients with MS. But, seasonal flu infections have been linked with flare-ups of MS.

Can vaccines cause infections?

Most vaccines contain inactivated vaccines. They have no living germs in them, so they can’t cause infections. Live vaccines (mumps, rubella, chickenpox, rotavirus and the nasal flu vaccine) contain weakened forms of the germs. These do not cause disease in healthy people although a few children will have a very mild rash and fever with MMR, MMRV or varicella vaccine.
Live vaccines may cause disease in people with conditions that prevent their immune system from working. These people should not be given these vaccines.

Vaccination and your child

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Vaccination is the best way to protect your child against many dangerous diseases. In Canada, vaccines prevent illnesses such as diphtheria, tetanus, pertussis (whooping cough), polio, Haemophilus influenzae type B (Hib), rotavirus, hepatitis B, measles, mumps, rubella, chickenpox, pneumococcal and meningococcal diseases, and human papillomavirus virus (HPV).

5-in-1 or 6-in-1 vaccine (also known as DPTP-Hib), DPT-polio, or Hib vaccine protects against diphtheria, tetanus, pertussis, polio, and Hib disease.
Rotavirus vaccine protects infants against rotavirus, the most common cause of serious diarrhea in babies and young children.
Pneumococcal vaccine protects against infections caused by Streptococcus pneumoniae, including meningitis (a brain infection), pneumonia, and ear infections.
Meningococcal vaccine protects against diseases caused by the meningococcus bacteria, including meningitis and septicemia, a serious blood infection.
MMR vaccine protects against measles, mumps, and rubella.
Varicella vaccine protects against chickenpox, a very uncomfortable and sometimes serious infection.
Hepatitis B vaccine protects against hepatitis B, a serious infection of the liver.
dTap vaccine protects adolescents against diptheria, tetanus and pertussis (whooping cough).
HPV vaccine protects against the types of HPV that cause cervical cancer, some other cancers, and genital warts.

If your child has a chronic health condition, other vaccines may be recommended. Speak to your physician.
You should also speak to a physician about vaccines that can protect your child while travelling.

Vaccines are very safe. There are rarely reasons not to get vaccinated.

What if my child is sick when the vaccine is due?

If your child is very sick when it’s time for a vaccine, talk to your doctor or health care provider.

The diseases prevented by infant and childhood vaccines are serious and even deadly. Measles can spread to the brain, cause brain damage and death. Mumps can cause permanent deafness. Polio can cause paralysis. Sadly, these diseases have not disappeared. There is no treatment and no cure for diseases like measles, polio and tetanus. The only way to protect your child is through vaccination.

A Guide for Parents :Reduce the Pain of Vaccination in Children Under 3 Years

Why is vaccination pain a concern?

Most vaccines are given with a needle. This can be painful and frightening for children.
Pain can cause a child to develop a fear of doctors, nurses and needles.
No parent wants to see a child in pain. Some parents delay or stop vaccinations because of pain. This can leave a child without protection from serious diseases.
Read this guide to learn about 3 ways you can reduce your child’s pain during vaccinations. These methods are proven to be safe and effective. You can combine the different methods for better results.
Plan what you will do for your child’s next vaccination.
Some strategies require preparation ahead of your child’s visit: 1) Sugar water can be prepared at home or at the clinic by mixing 1 teaspoon of sugar with 2 teaspoons of water. 2) Topical anaesthetics can be applied at home or at the clinic to numb the skin – these can be purchased at a pharmacy without a prescription. 3) Toys for distracting your child can be packed and brought to your child’s visit.

Keeping your child’s vaccination record up to date

Ask the doctor or nurse to give you a written record (usually by writing it in your child’s vaccine booklet) and take this record with you whenever you take your child to a doctor, a clinic or hospital. An up-to-date vaccine record is especially important if you move to a new province or territory, as vaccine schedules are not the same everywhere. Your child may miss vaccine doses if your new doctor or clinic does not know exactly which vaccines he has already received.

How can I minimize the pain?

Needles can hurt. To lessen the pain you can:
• Apply a topical anesthetic (a cream that causes temporary numbness) an hour before getting the needle. You may have to confirm with your doctor what part of your child’s body the shot will be given (for example, the arm or the leg). Your pharmacist can help you find the cream.
• Nurse your baby while he gets the needle, or give your baby sugar water (with a teaspoon or pacifier) just before the shot.
• Use distractions (blow bubbles, read a book), suggest deep breathing, remain calm and physically comfort your child (cuddle, hold hands) during the needle.
• If your child is crying or fussy after getting the shot, you can give her acetaminophen (such as Tylenol or Tempra).

What you can do

BREASTFEED YOUR BABY

If you are breastfeeding, start to breastfeed your baby before the needle. Make sure you have a good latch. Then continue breastfeeding during and after the needle.
Breastfeeding combines holding, sweet taste, and sucking and is one of the best ways to reduce pain in babies. • Breastfeeding during needles is safe for babies, even newborns. There is no evidence that babies will choke or associate their mothers with pain.
Undress your baby to free the leg(s) or arm(s) where the needle will be given before you start breastfeeding.
If your child cannot be breastfed, you may bottle feed your child or give a soother before, during and after vaccination.

HOLD YOUR CHILD

Hold your child on your lap or hug your child during the needle. This will help your child stay still and feel secure.
Sit on a chair to minimize the risk of accidental falls.
Make sure to undress your child to free the leg(s) or arm(s) where the needle will be given
Don’t hold your child too tightly. This can increase pain and distress.
You may rock your child back and forth after the needle

What you can give

SUGAR WATER

You can use sugar water to reduce your child’s pain.
Sugar water is safe for children, even newborns.
Make sugar water at home or at the clinic by mixing 1 teaspoon of white sugar with 2 teaspoons of distilled or boiled water. For babies over 6 months, you may use tap water if the tap water is safe for drinking.
Give your child some sugar water 1 to 2 minutes before vaccination, using a dropper (or syringe). Place it into the side of your child’s mouth between the cheeks and gums. • If your child uses a soother, the soother can be dipped into the sugar water and given to your child during the needle. Combining sugar water with a soother and holding your child can simulate aspects of breastfeeding.
If your child is getting a vaccine called rotavirus, then you do not need to give sugar waterbecause the rotavirus vaccine has sugar in it

TOPICAL ANAESTHETIC CREAM, GEL OR PATCH

EMLA™ (lidocaine-prilocaine), Ametop™ (tetracaine), or Maxilene™ (lidocaine). • They dull pain where the needle enters your child’s skin.
They are safe for babies, even newborns.
Apply them at home or at the clinic before the needle.
For babies under 1 year of age, apply to the upper outer part of the leg; for children aged over 1 year, apply to the upper arm. Conﬁrm the location with your child’s health care provider. If your child is getting more than one needle, apply to both legs or both arms.
You have to wait for topical anaesthetics to take effect. Apply to injection site between 30 and 60 minutes before the needle, according to manufacturer instructions.
Remove the medicine after the waiting time. Your child’s skin may appear whiter or redder than normal. This is OK and will go away.
Allergic skin reactions are rare. If there is a rash, talk to your child’s health care provider about it. It could be an allergic skin reaction. If your child experiences an allergic skin reaction, use another product the next time.

How you can act

YOUR STATE OF MIND :

Try to stay calm, use your normal speaking voice, and be positive before, during, and after the needle. This will help your child stay calm. Children see and feel what their parents are doing, and often do the same.
Avoid using reassuring statements like “It’ll be over soon” and “You’re OK”. Reassurance can increase distress and pain.
If you are nervous, you can take a few slow, deep breaths to calm yourself. Breathe so your belly expands, not your chest. You can do this while holding your baby.

DISTRACT YOUR CHILD :

Taking your child’s focus away from the pain can reduce your child’s pain.
While holding your baby close, distract with videos (for example, mobile devices), toys and music.
Start distracting your child before the needle but distract only when your child is calm enough to do so; otherwise, distress may be increased.
The way you distract your child once may not work the next time. Be prepared to change what you are doing to keep your child distracted