These come as an increasing number of parents are giving more scrutiny to vaccines, prompted by controversies over side effects and the withdrawal of a problematic antidiarrheal vaccine from the market.

Meanwhile, medical experts continue to say that vaccine benefits far outweigh the small risk of adverse reactions.

What all sides agree on is that parents need to stay well-informed.

Here's a primer on the new immunizations:

Pneumocococcal vaccine

A pneumococcal vaccine, which is expected to win Food and Drug Administration approval within six months, would offer protection against pneumococcal meningitis, bacteremia, pneumonia and acute otitis media, or ear infections.

This is "among the most exciting vaccine events to happen in the last decade," said Dr. Edgar Marcuse, University of Washington professor of pediatrics and director of medical services at Children's Hospital & Regional Medical Center.

Pneumococcal meningitis, which affects 1,500 children under age 2 each year in the United States, can result in hearing loss, permanent neurologic disabilities and death. Each year 9,000 children under 2 contract bacteremia, an infection of the blood, which can also be fatal.

Additionally, the vaccine will reduce ear infections, one of the most common childhood illnesses. The vaccine blocks seven common strains of bacteria, but dozens remain. "We can't say children won't get infections, just fewer of them," Marcuse said.

Though studies found the vaccine reduced overall ear infections by only 7 to 20 percent, children suffer an estimated 7 million ear infections a year - so even a small percentage is a significant number. The vaccine is expected to cut the number of chronic infections by a fifth, which will mean fewer children with ear-draining tubes.

Some physicians worry other strains will just take over, but researchers are committed to adding more strains to the vaccine as needed, said Dr. Mark Greenfield, a pediatrician with Seahurst Pediatrics in Burien.

The vaccine is especially important now that some strains are showing resistance to antibiotics, Greenfield said.

A Centers for Disease Control and Prevention advisory committee gave the pneumococcal vaccine a preliminary vote of confidence and expects to recommend it universally once it is licensed by the FDA, said Barbara Reynolds, a CDC spokeswoman.

To date, studies have found no major side effects; some children react with local redness, soreness and a low-grade fever, Marcuse said.

In Washington, it may be 18 months to two years before the vaccine is widely available. Most physicians wait for new vaccines to be distributed free by the state, though parents can request individual shots purchased directly from the drug manufacturer. Some insurance companies cover this; others require parents to pay out-of-pocket.

Though doctors are sometimes leery of new vaccines, local physicians say they are eager to use the pneumococcal one.

"If it's as effective as studies suggest it will be, it will wipe out a lot of illness and misery for kids," said Dr. Robert Hauck, a pediatrician with Richmond Pediatric Clinic in Shoreline. "I think doctors are going to jump on the bandwagon pretty quickly."

The pneumococcal shot will not be required for school entry "for quite a long time, if ever," said Cindy Gleason, health educator in the Washington State Health Department's immunization program.

Instead, pneumococcal will likely join chickenpox as a vaccination the state provides for free but by request only. Assuming it is endorsed by the national Advisory Committee on Immunization Practices, the vaccine must then be approved by a state advisory committee and receive funding.

Washington is a universal-distribution state, meaning it supplies all required vaccinations at no cost to both public and private clinics. Patients are charged only administrative fees. The increased demand of including new vaccines in this list is expensive, so officials have to weigh the benefits, Gleason said.

"Diseases such as measles and polio (required vaccinations) caused so many severe illness and epidemics," Gleason said. "Chickenpox is not at the same level. That's where the pneumococcal would fall in, too."

Hepatitis A

A statewide advisory committee recently recommended routine hepatitis A vaccinations for children in King County and 12 other counties with double the national rate of infections.

A single hepatitis A shot is given to children age 2 and up. The only known side effects are local irritation and low-grade fever.

For now, the vaccination will be recommended but not mandatory for school admission, though a requirement may be phased in over the next five years, Gleason said.

The vaccine won't be widely distributed to physicians until at least summer, when state funds become available.

Currently, the state provides vaccinations only at sites (schools, restaurants) where outbreaks of the liver disease occur; travelers can also request the vaccination.

The hepatitis A virus, which is characterized by jaundice (yellowish skin), fever, severe fatigue and nausea, is most commonly spread through food contaminated by the feces of an infected person. The infection is serious but people do recover; there is no long-term damage, Gleason said.

Last February, the Centers for Disease Control recommended that Washington and 10 other states consider routine pediatric hepatitis A vaccination. The state's 10-year rate for the disease is about three times the national average - 30 per 100,000 vs. 10 per 100,000.

In 1998, 400 cases were reported in King County, mostly in male adults. Over the past decade, about 6 percent of county cases have been linked to day-care centers.

Immunizations in Pierce County will be by request only as its rate (12.6) is only slightly higher than the national one. The Snohomish County rate is less than average and vaccinations there will be for outbreaks only.

Physicians are divided on the need for routine hepatitis A shots. Most see cases in children only rarely, but on the other hand, "it is preventable with a safe and easy vaccine," said Dr. Danette Glassy, president of the Washington Chapter of the American Academy of Pediatrics.

Preservative-free hepatitis B

Last year, expert groups became concerned that infants who received the two hepatitis B shots being recommended at birth and 2 months would be taking in an amount of mercury that reaches the upper limits of FDA guidelines.

Traditionally, the mercury-based preservative thimerosal has been used in hepatitis B shots. Mercury poisoning can cause neurologic damage.

In response, the drug manufacturer recently started offering mercury-free vaccines, but supplies are short; the state's limited batch has gone to to hospitals for shots given at birth.

Many physicians are waiting until babies are six months old, rather than the standard two months, for the second dose of the hep B vaccine, which currently still contains thimerosal.

If your baby has already had a dose with the preservative, Marcuse said, there's no call to worry. The new moves are only a precaution; no cases of mercury poisoning have been reported. And the CDC says its studies have to date found hepatitis B to be one of the safest vaccines.

The preservative is not a concern with older children since they weigh more and the proportion of mercury in the body is smaller, Marcuse said. A third dose is given between 6 and 18 months.

The three hepatitis B vaccinations are required for day care and school entry. Hepatitis B is a serious disease that attacks the liver. Children who catch it can be contagious even if they don't show any symptoms.

Other vaccines

Influenza vaccine: A working group of the CDC's vaccine-advisory committee is evaluating recent studies (including one released by the University of Washington) that recommend routine flu shots for children, but there's no decision yet.

Polio: Children will no longer take the oral vaccine for polio, which was made from a weakened, live form of the virus and in rare cases - five times in 1997, once in 1998, for example - caused polio. Jonas Salk's injectable vaccine, which cannot cause the disease, is now used exclusively in all four doses of the vaccine.

Whooping cough: A new version of the pertussis (whooping cough) vaccine, given in combination with other vaccines as the DTaP, now is widely available and being used almost exclusively, Gleason said. Recent research confirms that the revamped version has far fewer serious side effects than the older one, which had prompted complaints from parent groups.

Rotavirus: Last year, manufacturers withdrew a rotavirus vaccine from the market because of increased incidents of bowel obstruction. A replacement vaccine to prevent this diarrheal disease is not expected for another two to three years.

Rotavirus complications were not an issue in Washington because the vaccine was withdrawn before the state began distributing it.

Weighing risks

Not everyone is enthusiastic about this year's developments.

"When any new vaccine comes out, we're very concerned," said Barbara Loe Fisher, president of the National Vaccine Information Center. Her group opposes vaccine mandates and advocates better parental education about potential risks.

"Physicians need to tailor procedures to the individual, rather than having policy be supreme," she said.

(The state allows parents to seek medical, personal or religious exemptions to vaccination mandates.)

The rotavirus suspension is a positive example of the medical establishment recognizing red flags, Fisher said. "But the question is, how did the vaccine get through all the hurdles without the (bowel obstruction) issue coming up?" she said.

Experts acknowledge the unknowns. "There is always the possibility of rare side effects that even large studies cannot recognize," said Marcuse. "And we can never say with absolute certainty what will happen in 20 years."

However, Marcuse said, parents shouldn't shy from new vaccines. "`Safe' is a relative term, measured against the risks of the disease."

Stephanie Dunnewind can be reached at 206-464-2091. Her e-mail address is sdunnewind@seattletimes.com.<>