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Painful Vs Painless Vaccination For Babies: Which Is Better?

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The pain and other reactions associated with injections can be a reason for hesitation to vaccinate babies. Studies from the US and Canada indicate that 24–40% of parents are concerned about vaccination-associated pain in children and 85% believe healthcare providers have a responsibility to make vaccinations less painful. Painless vaccines are promising and help bring down anxiety. Read this MomJunction post to know more about the painless vaccination, its safety, effectiveness, advantages, and disadvantages compared to the conventional painful vaccination.

What Are Painless Vaccines?

Vaccination can cause pain either due to the method of delivery or due to post-vaccination reactions. Conventional or painful vaccines that are delivered through an injection often cause pain at the injection site. However, pain during vaccination sessions is manageable and managing pain does not decrease the efficacy of the vaccine. Also, there are a number of painless vaccine delivery systems in practice.

The painless routes of administrationinclude oral and nasal.

Despite the benefits of the painless route of delivery, to date, most of the vaccines are available as injection shots only.

Painless mucosal vaccines:

  • Intranasal influenza and oral polio vaccines are examples of successful,painless mucosal vaccinations. These vaccines are cost-effective compared to the injections and are ideal for vaccinations of the mass population (1).
  • Flumist is one of the live attenuated influenza nasal vaccines for children againstthe influenza virus. Rotarix and RotaTech against rotavirusDukoral for cholera, Vivotif against typhoid fever, and Sabin live OPV (oral polio vaccine) are some of the licensed oral vaccines (2).
  • These vaccines are easy to administer, safe, and several of the vaccines do not require cold chain maintenance (storage under low temperature until delivery). In comparison, an injection vaccine could require an unbroken cold chain during production, storage, and distribution.
  • Oral polio vaccines have been a great success, and it helped eradicate polio in countries like India. The country was listed by the global polio eradication initiative (GPEI) as the most difficult region in the world to eliminate wild poliovirus transmission (3).

The nasal and oral route makes for a painless vaccine administration. However, when there is a discussion of painless vaccination, most think of painless injection vaccines, which have been a current trend in many countries.

What Are Painless Injection Vaccines?

Acellular vaccines are known as painless vaccines. This type of vaccine contains a part of the cell, such as the antigenic part, then a complete cell of pathogens. Theacellular vaccines are called painless since less immune reaction occurs after the delivery of vaccines compared to the body’s response to a whole-cell vaccination.

Painless vaccines are not exactly painless, and babies may still have pain due to injection. The pain in babies is usually noted based on post-vaccination behavior such as crying.

One of the main painless vaccines for babies is the DTaP vaccine, which contains diphtheria and tetanus toxoids (chemically modified pathogenic toxin) and an antigenic component of Bordetella pertussis.

Is It Safe To Give Painless Vaccinations For Infants?

All licensed and recommended vaccines are safe and effective because they are made with high safety standards. Vaccines are licensed by the Food and Drug Administration (FDA) and recommended by the US Centers for Disease Control Prevention (CDC) after several years of safety tests and evaluation. Every batch of vaccines undergoes quality control before availing theiruse (4).

If your country’s policies include acellular vaccines in the immunization schedule, then you may choose them based on the pediatrician’s advice. It is important to vaccinate your child for pertussis, and it doesn’t matter if your child receives a whole-cell painless or painful vaccination since both can create effective immunity against the disease.

Painless Vs. Painful Vaccination – Which Is Better?

All licensed and recommended vaccines are effective. The following are some essential points about painless versus painful vaccination.

  • According to the CDC, the studies conducted to evaluate the effectiveness of acellular vaccines have shown them to be as effective as whole-cell vaccines (6).
  • Three doses of acellular vaccine can produce a similar range of protection against moderate and severe pertussis disease as a whole-cell vaccine. The local reactions, such as pain, swelling, redness, and systemic reactions such as fever, were mild in acellular or painless vaccination (6).
  • Severe adverse effects such as persistent crying (crying for more than three hours), high fever, hypotonic and hyporesponsive episodes, and febrile seizure were less frequent among infants, who received DTaP (6).

Limitations of painless vaccine

During the pertussis outbreak in 2009 and 2010, teens who were vaccinated with DTaP in infancy had a higher risk of contracting pertussis than the teens who received the whole-cell vaccine (7).

Due to the outbreaks of pertussis reported in some countries despite the use of acellular pertussis vaccine, the Indian Academy of Pediatrics recommends the whole-cell vaccine for primary immunization in infants, and the acellular vaccines only for specific cases (5).

Many industrialized countries use acellular vaccines. The lasting immunity and requirement of a booster dose in teens may have to be studied further for more details. Your child’s pediatrician can also give you information about any ban on painless vaccinations in your country.

Despite the several instances of comparison between the painless and painful versions of the vaccine, there is a scarcity of conclusive data about the effectiveness of DTP and DTapvaccines. More case-control studies are required to look for the rare severe adverse effects such as encephalopathy and anaphylactic shock (lower blood pressure due to anaphylaxis or an allergic reaction).

Advantages Of Painless Vaccination

Compared to whole-cell vaccines,acellular vaccines are less painful and cause a minimal post-vaccination reaction. Advantages of painless vaccination may include:

  • Less systemic reactions, such as high fever, hypotonia, etc.
  • Low rates of local reactions such as swelling and redness (erythema) at the injection site.
  • Combination painless vaccines can give effective immunity to many infectious diseases at once.
  • Intranasal and oral vaccines are easy to give and cost-effective.

Clinical trials have shown that acellular vaccines have a lower rate of adverse events than whole-cell pertussis vaccines. However, this may still cause pain. Studies report that a fewinfants experience vaccination side effects,such as severe pain (8).

What Is The Cost Of Painless Vaccination For Babies?

Painless vaccination may cost more than older whole-cell vaccines. You may seek advice from your baby’s pediatrician for a routine vaccination schedule, available vaccines, and costs. Vaccine prices may vary in different countries, and some may get free vaccination as per the government policies.

Daptacel, Infanrix, Kinirix, Pediarix, Pentacel, and Quadracel are available licensed pediatricDTaP vaccines in the US (9). These vaccines can cost from $18 to 62 if you go for immunization programs included in the CDC funds, such as the state health departments. Private sector vaccinations may cost around $31 to 100 (10).

One time booster dose is also recommended for adults, especially those who are in contact with children younger than 12 months (11). The booster shot for adults and older children may incur an extra cost. You may seek your healthcare providers’ advice to choose the appropriate immunization programs which are convenient and cost-effective.

Major drug companies are researching needle-free and painless delivery systems of vaccines. We may even hear about edible vaccines and dry powder vaccines in the near future. Clinical trials are conducted to assess painless transdermal vaccine delivery using jet injections, microneedles, andnano vaccine patches (1). Research may eventually lead to the development of painless and cost-effective vaccines for a widespread population.

References:

1. NehaGarg and AnjuAggarwal; Advances Towards Painless Vaccination and Newer Modes of Vaccine Delivery; The United States National Library of Medicine (NLM)
2. Julia E. Vela Ramirez, et al.; Current state and challenges in developing oral vaccines; The United States National Library of Medicine (NLM)
3. Naveen Thacker, et al.; Polio Eradication in India: The Lessons Learned; The American Academy of Pediatrics
4. Vaccine Safety; The United States Department of Health & Human Services
5. Vipin M Vashishtha, et al.; Pertussis Vaccines: Position Paper of Indian Academy of Pediatrics (IAP); The United States National Library of Medicine (NLM)
6. Pertussis Vaccination: Use of Acellular Pertussis Vaccines Among Infants and Young Children Recommendations of the Advisory Committee on Immunization Practices (ACIP); The Centers for Disease Control and Prevention
7. Whole cell vs. Acellular pertussis vaccine affects disease risk; The American Academy of Pediatrics
8. Maria Rosario Capeding, et al.; Immunogenicity and safety of a DTaP–IPV//PRP~T combination vaccine given with hepatitis B vaccine: a randomized open-label trial; The World Health Organization
9. About Diphtheria, Tetanus, and Pertussis Vaccines; The Centers for Disease Control and Prevention
10. CDC Vaccine Price List; Vaccines For Children program (VFC); The Centers for Disease Control and Prevention
11. Acellular Vaccines for Preventing Pertussis in Children; The American Academy of Family Physicians