HOW MANY VACCINES IS THAT?

Extreme hyperbole seems to be a common tactic for anti-vaxxers to use.  Comparing pediatricians to "nazis", vaccine mandates to "fascism", vaccine research to "Nuremberg", and the administration of vaccines to "murder", the misrepresentations are plentiful from the anti-vaccine side.

Even looking at the CDC recommended vaccination schedule, extreme hyperbole is employed by anti-vaxxers to frighten parents.  Either it's intentional misinformation or just really bad counting skills.  Or maybe it's a combination of both being used to promote "fear appeal".

A few examples demonstrating that, even amongst anti-vaxxers, the number of "vaccines" they claim varies greatly.

"74 injected vaccines by 4-6 years" 

"49 doses of 14 vaccines by age 6"

"74 vaccines"

"81 vaccines by 6 years of age"

So how many vaccines does a child actually receive?

To clarify, we need to define a few terms first.

and

and

and

A injectable vaccine dose is 0.5 mL for most vaccines with one exception:  the dose of influenza vaccine we give at 6 months of age and then at least a month later are 0.25 mL each.  A vaccine such as DTaP, Pediarix, Proquad, or MMR - although they are polyvalent, are still 0.5 mL in a single dose.

Using my own practice as an example, there are several different ways to "count".

Method one:  How many actual vaccines do we use in our office?

Engerix (not actually given in our office - birth dose given at hospital)

Pediarix
PedVaxHiB
Prevnar 13
Rotateq
Fluzone
MMR
Varivax
Havrix
Kinrix
Proquad
Menactra
Trumenba
Gardasil
Adacel

Total: 15 actual vaccines  

Method two:  If we count by the number of diseases we protect against with vaccines:

Hepatitis B (Hep B)
Diphtheria
Tetanus
Pertussis
Polio (IPV)
Streptococcus pneumoniae (S pneumo)
Hemophilus influenza type B (HiB)
Rotavirus (rota)
Influenza (flu)
Measles
Mumps
Rubella
Varicella (Chickenpox)
Hepatitis A (Hep A)
Neisseria meningitidis ACWY  (meningococcal ACWY)
Human Papilloma Virus (HPV)
Neisseria meningitidis B (meningococcal B)

Total:  17 diseases we protect against

Method three:  I'm not aware of any practice that doesn't use combination vaccines but for the sake of argument, the number of injections if no combination vaccines were used  for a child who receives every single possible recommended vaccine exactly on time without the availability of FluMist in my office:

Birth dose Hep B = 1 injection
2 months of age:  DTaP, IPV, Hep B, Prevnar, HiB, Rotateq = 5 injections (1 oral)
4 months of age:  DTaP, IPV, Hep B, Prevnar, HiB, Rotateq = 5 injections (1 oral)
6 months:  DTaP, Hep B, IPV, Prevnar, influenza, Rotateq = 5 injections (1 oral)
12 months:  MMR, Hepatitis A, Prevnar, influenza = 4 injections
15 months:  Varivax, HiB, DTaP = 3 injections
18 months:  Hepatitis A, influenza = 2 injections
3 years:  influenza = 1 injection
4 years:  DTaP, IPV, MMR, Varivax, influenza = 5 injections
5-10 years:  influenza = 6 injections
11 years:  HPV, Menactra, Tdap, influenza = 4 injections
12 years:  HPV, influenza = 2 injections
13-15 years:  influenza = 3 injections
16 years:  Trumenba, Menactra, influenza  = 3 injections
17 years:  Trumenba, influenza = 2 injections
18 years: influenza =1 injection

Total: 32 injections by age 6 if no combination vaccines are used (29 injections if we use FluMist)

52 injections by age 18 if no combination vaccines are used (33 injections if we use FluMist)

Method four: Number of actual injections given to a child who receives every single possible recommended vaccine exactly on time without the availability of FluMist in my office (including birth dose of hepatitis B that we don't actually give in our office)


Birth dose Hep B = 1 injection
2 and 4 months of age:  Pediarix, Prevnar, HiB, Rotateq = 6 injections (2 oral)
6 months of age:  Pediarix, Prevnar, Rotateq, influenza in the winter = 3 injections (1 oral)
12 months:  MMR, Hepatitis A, Prevnar, influenza = 4 injections
15 months:  Varivax, HiB, DTaP = 3 injections
18 months:  Hepatitis A, influenza = 2 injections
3 years:  influenza = 1 injection
4 years:  Kinrix, MMRV, influenza = 3 injections
5-10 years:  influenza = 6 injections
11 years:  HPV, Menactra, Tdap, influenza = 4 injections
12 years:  HPV, influenza = 2 injections
13-15 years:  influenza = 3 injections
16 years:  Trumenba, Menactra, influenza  = 3 injections
17 years:  Trumenba, influenza = 2 injections
18 years: influenza =1 injection

Total:  25 injections by age 6 (with FluMist, there would be 22 injections total)

44 injections by age 18 years  (with FluMist, there would be 28 injections total)

Method five:  If we count by the number of doses of a vaccine with the same conditions as method four: 

Total:  47 doses (44 injections + 3 oral doses) by age 18 years

Method six  If we count by the number of "pathogens" with the same conditions as above:

birth dose hep B :  1 pathogen
2 and 4 months of age:  Pediarix (diphtheria, tetanus, pertussis, polio, hep B), Prevnar, HiB, rota = 16
6 months of age:  Pediarix (diphtheria, tetanus, pertussis, polio, hep B), Prevnar, Rotateq, influenza = 8
12 months:  MMR (measles, mumps, rubella), Hepatitis A, Prevnar, influenza = 6
15 months:  Varivax, HiB, DTaP (diphtheria, tetanus, pertussis) = 5
18 months:  Hepatitis A, influenza = 2
3 years:  influenza = 1
4 years:  Kinrix (diphtheria, tetanus, pertussis, polio), MMRV (measles, mumps, rubella, varicella), influenza = 9
5-10 years:  influenza = 6
11 years:  HPV, men ACWY, Tdap (tetanus, diphtheria, pertussis), influenza = 6
12 years:  HPV, influenza = 2
13-15 years:  influenza = 3
16 years:  men ACWY, men B, influenza  = 3
17 years:  men B, influenza = 2
18 years: influenza =1

Total:  72 "pathogens" by age 18 (many of which are the same pathogen)

Method seven:  include all the "pathogens" in method six and also throw in the maternal doses of influenza and Tdap (tetanus, diphtheria, pertussis):

Total number of "pathogens":  76 "pathogens" by age 18

Method eight:  include all of the "valences" or strains covered in method six:

birth dose hep B :  1 valence or strain
2 and 4 months of age:  Pediarix (diphtheria, tetanus, pertussis, polio, hep B), Prevnar (13 strains), HiB, rotateq (5 strains) = 48
6 months of age:  Pediarix (diphtheria, tetanus, pertussis, polio, hep B), Prevnar (13 strains), Rotateq (5 strains), influenza (4 strains) = 27
12 months:  MMR (measles, mumps, rubella), Hepatitis A, Prevnar (13 strains), influenza (4 strains) = 21
15 months:  Varivax, HiB, DTaP (diphtheria, tetanus, pertussis) = 5
18 months:  Hepatitis A, influenza (4 strains) = 5
3 years:  influenza (4 strains) = 4
4 years:  Kinrix (diphtheria, tetanus, pertussis, polio), MMRV (measles, mumps, rubella, varicella), influenza (4 strains) = 12
5-10 years:  influenza (4 strains) = 24
11 years:  HPV (9 strains), Neisseria meningitidis ACWY( 4 strains), Tdap (tetanus, diphtheria, pertussis), influenza (4 strains) = 20
12 years:  HPV (9 strains), influenza (4 strains) = 13
13-15 years:  influenza (4 strains) = 12
16 years:  men ACWY (4 strains), men B, influenza (4 strains)  = 8
17 years:  men B, influenza (4 strains) = 5
18 years: influenza (4 strains) =4

Total: 209 valences or strains  by age 18 (many of which are the same strains)

So, in summary:

• "74 injected vaccines by age 4-6"?  

False.  By age 6, a child in my office receives, at the most, 25 injections (22 if we use FluMist)

• "49 doses of 14 vaccines by age 6"?  

False.  By age 6, a child in my office receives, at the most, 28 doses of 11 vaccines. 

• "81 vaccines by 6 years of age"?  

False.  By the age of 6, a child in my office receives, at the most, 25 injections or 28 doses of 11 vaccines

• "69 doses of 16 vaccines by age 18"?

False.  By the age of 18, a child in my office receives, at the most, 47 doses of 15 vaccines. 

I suppose if you're going to accurately exaggerate what vaccines do, the claim would be 209 valences/strains by age 18 but that just doesn't sound nearly as scary.  The take home message here is that we have the ability to protect against 17 different diseases that cause significant harm and we can do so safely and effectively.