Why We Need Vaccines
There are tons of germs out there, and unless you keep your baby in a bubble, she is going to be exposed to a lot of dangerous bacteria. Our natural immunity can fight off many viruses and certain bacteria, but there are some very serious illnesses that we just can’t fight off without help.
When pediatricians evaluate a seriously ill child with a high fever, we conduct tests: blood, urine, and even spinal fluid exams. That’s how we get clear statistics on the rates of bacterial illnesses each year. Luckily, many of these diseases are not very common, but they are still very real and pose a significant risk to a young child. One of the benefits of a cleaner society has been fewer epidemics and fewer deaths attributable to infectious diseases. But if we relax our guard, and fail to protect our children, we will definitely see the rise of some horrible infections.
Looking Back
If we look to our not-so-distant past, we realize just how far we’ve come in preventing some of the most dreaded infectious diseases. In the 1940s and ’50s, people lined up around the block for their polio vaccines. Polio was one of the most dreaded childhood diseases of the 20th century in the United States. Polio epidemics crippled thousands of people, most of them young children, each year. Parents were terrified of polio leaving their children unable to walk or forcing them to spend the rest of their lives in an iron lung. Since the polio vaccine became available, the disease has more or less disappeared from this country, but it still is rampant in many parts of the world. Travelers come to New York all the time, so if our immunity as a society waned, there could definitely be another outbreak here.
Then there is the HIB germ, which was rampant in the 1980s and was the leading cause of meningitis and pneumonia in children. That germ has virtually disappeared because of a successful vaccination program. Literally thousands of deaths have been prevented.
The pneumococcus germ (a form of strep) remains one of the most common causes of meningitis, pneumonia, and even ear infections. Since the creation of the prevnar pneumococcus vaccine, the rates of children admitted to the hospital with this germ have gone down significantly. This germ specifically affects younger children, so once a child is over 2 years old, the risk goes down. But the risk is highest among 6- to 24-month-olds, so delaying that vaccine puts a baby at risk!
Measles is also a very serious disease. It is the leading cause of death among young children, even though a safe and cost-effective vaccine is available to prevent it. In 2007, there were 197,000 measles deaths globally—nearly 540 deaths every day or 22 deaths every hour. More than 95 percent of measles deaths occur in low-income countries with a weak health infrastructure. Measles vaccination efforts have resulted in a 74% drop in measles deaths between 2000 and 2007 worldwide. If we fail to vaccinate against measles, the disease burden seen abroad will surely return to the United States.
The Concern About Vaccines
There are more vaccines now than ever before. But the body’s immune system reacts to the antigens in each vaccine, and that number has actually decreased. Nowadays, vaccines are better targeted and therefore do not overwhelm a baby’s immune system. Smaller doses are administered, and “booster shots” are subsequently given to build the immune system slowly.
All vaccinations have potential side effects, but when you weigh the risks and benefits, vaccines have significantly improved the well being of our children. Yet there has been a media frenzy in the past decade that has led to a real cynicism regarding vaccine safety—specifically, their relationship to autism.
This started in 1998, when Dr. Andrew Wakefield, a gastroenterologist from England published a study postulating a link between the MMR (mumps, measles, rubella) vaccine and autism. The problem with his study was that it was very flawed. He used a self-selected group of patients—those already referred to him with problems, not a random placebo controlled double blinded study with neutral unbiased observers—and the number of people he studied was very small—certainly not enough to prove anything.
Nonetheless, when word got out that there was even a possibility of a link to autism, fear spread like wildfire. Indeed, the number of children diagnosed with autism continues to go up and no one knows why. Moreover, an autism diagnosis is typically given around 12 or 13 months of age, and because the MMR vaccine is given at 12 months, the timing seemed to support the link.
But since 1998, there have been numerous large randomized clinical studies clearly showing that there is no link between MMR and autism. Dr. Wakefield himself has retracted his results, and the journal that published the article has issued an apology for the flawed study. The results of properly done studies are pretty straightforward; in a group of 250,000 patients in Denmark where some did get the MMR vaccine and some did not, it was clear that in kids who did not receive the MMR vaccine, the rate of autism was the same.
Also blamed for the rise of autism is thimerosal, a preservative that was used for vaccines that can be broken down to a mercury compound. The toxic effects of mercury have been known for a long time. The Mad Hatter in Alice in Wonderland, like many hatters of the old days, handled mercury in his trade and suffered the consequences. But there is a big difference between methyl mercury, which is toxic and can get into the central nervous system, and ethyl mercury (the thimerosal compound), which is less potent and can’t get into the nervous system.
Nevertheless, after a fear over mercury developed, the American Academy of Pediatrics demanded that all vaccines be made without this preservative. Since 2001, all vaccines (with the exception of some adult flu vaccines) are not preserved with any mercury component. Nonetheless, autism cases have continued to increase in the past eight years, so the culprit is clearly not thimerosal.
The causes of and potential cures for autism remain a mystery, but scientists, politicians, activists, and pediatricians are 100% behind the efforts to solve it. The only thing that seems clear at the moment is that vaccines are not at the root of the problem.
Why Is Autism on the Rise?
Part of the reason why there has been an alarming increase in the incidence of autism is because we are now able to screen for and identify signs of autism much earlier than before—even before a child reaches his first birthday. Not long ago, children with autism were often misdiagnosed; they were labeled as mentally retarded or speech delayed, or just missed altogether. Nowadays, everyone from parents to teachers to doctors is vigilant in the search for autism, and this contributes to an increase in cases officially diagnosed.
There is a genetic basis to autism, and researchers are currently looking for a gene that predisposes a child to the condition. There may also be something in the environment that causes autism. It may be something that mothers were exposed to while pregnant, as the most common forms of autism are apparent in newborns. The case of a child developing normally and talking well, only to spontaneously regress, is actually quite rare, and not your typical autistic child. The usual presentation of autism includes the inability to form interactions, connections, or communication skills, not a loss of skills that were already acquired.
Splitting or Altering the Vaccination Schedule
Nowadays, people worry that there are too many vaccines, and that the immune system will be overwhelmed. The problem has been thoroughly studied by scientists and that is how the current vaccination schedule has been created. Before a vaccine is added to the schedule, there are many studies conducted to measure the success of the immunity based on blood tests and any side effects. The most common side effects are fever and muscle aches or soreness. But the vast majority of babies and children have absolutely no reaction to any vaccines.
We have already determined that giving a vaccine to a child before they are 6 weeks old is not as effective. But after 6 to 8 weeks, a child’s immune system can and does accept and incorporate the passive immunity afforded by the vaccines. The vaccination schedule allows a child to develop enough immunity to have the best chance to fight off the germ by the time the child is most likely to encounter that germ. If parents feel more comfortable splitting the first few rounds of vaccines—in other words, instead of getting all the shots in months 2, 4, and 6, getting some in months 3, 5, and 7—the delay of one month is not a big risk to the child. I personally think the child would rather get it over with in three days of pain rather than six, but I try to make the parents feel comfortable.
Dr. Bob Sears is a pediatrician who has written a book promoting an alternative, delayed schedule. He raises many good theoretical questions—like can aluminum preservatives in vaccinations cause harm—but he offers few answers, and he may only be adding fuel to the fire. And there have been reports in pediatric journals about some babies getting illnesses that were preventable because they were on a delayed schedule
So Who Can We Trust?
I was raised by a midwife mom who created a doula company more than 20 years ago, and a dad who was one of the original consumer reporters—always looking out for scams and companies not telling the whole truth. In medical school, I was a bit skeptical of Western medicine at first, and I challenged a lot of what is taught. Pharmaceutical companies provide huge financial incentives for doctors, and I have observed firsthand the shortcomings of the FDA.
But now I balance that skepticism with what I’ve seen in my 21 years of caring for children. Children with pneumonia or blood infections can suffer greatly, and meningitis can even take their lives. Such extreme cases require treatment with antibiotics.
I take a balanced approach to medicine, and I am sure that the benefits of antibiotics and vaccinations outweigh any theoretical risks. I had to reexamine all of my beliefs when I went through the vaccination schedule with my own daughter, but she received them all and did just fine.
The best plan is to find a good pediatrician who you can trust—someone who is very well trained, intelligent, and able to analyze the information that’s out there. They must also possess the ability to work well with any type of family. I believe that informed parents should be able to make the final decision when it comes to their children. I don’t turn away any family, even those that refuse all vaccines. But the thing that parents need to remember is that even with the Internet, medicine is a doctor’s area of specialty. I stand over the plumber when he fixes the sink, and I nod my head a lot when the mechanic fixes the car. I research the stock market and certain laws. But in the end, I trust in the experts of these fields. With our children’s health at stake, we have to be comfortable following the advice of their doctors. I hope that I can be that person when it comes to infectious diseases, vaccines and the array of perplexing pediatric issues.
Our Vaccination Schedule
We use a combination vaccine called Pentacel that is safe, effective and without any increase in side effects. It combines Dtap, Polio, and HIB into one needle. When there is a Pentacel shortage, we use Pediarix instead. The other vaccines for the 2-, 4-, and 6-month visits are the oral rotavirus vaccine, the prevnar (PCV or pneumococcus) vaccine and the Hepatitis B vaccine. That is a total of three needles and one oral vaccine. For those parents who feel strongly that we should give only two needles, we can delay the Hepatitis B vaccine until later, as long as both parents are definitely Hep B negative on blood tests and are willing to take the very small but real risk that there could be Hep B contact through events such as blood transfusions or human bites.
For those parents insisting on splitting the vaccines into two separate schedules, we could give the Pentacel and rotavirus ones on months 2, 4, and 6, and the Prevnar and Hep B on months 3, 5, and 7. I feel strongly that any further delay in the vaccines is not safe, but if both parents insist on delaying the vaccines in a different way or forgoing some vaccines altogether, I will do my best to guide and support you. In those cases, I will need you to sign a statement saying that you are aware of the risks of not vaccinating your child. I will also need you to give me in writing your proposed schedule.
After the first three rounds of the Pentacel, PCV, Hep B and Rota, we would take a break until 12 months old. At 12 months, we would give the MMR, Varicella, and Hepatitis A vaccines. At 15 months, we would give the fourth (and last) HIB and Prevnar vaccines. Then at 18 months, we would give the final Dtap and second Hepatitis A.
At 4 years old there are four booster vaccines: Dtap, Polio, MMR and Varicella. We have two safe combo vaccines, the Kinrix and Proquad, so you only need two needles at that four year visit. At 11 years we would give the Tetanus (Tdap) booster, as well as the meningitis (meningococcus) shot.
Girls and boys can get the gardasil/HPV vaccines at any age after 9.
We also recommend the flu shot for all children every year, but especially for those with asthma or who are younger than 6 years old. The first time children get a flu shot, they will need a booster one month later if they are less than 9 years old. If they are younger than 3 years old, the dose is smaller (.25ml instead of .5ml).
All of the vaccines, except certain adult flu shots, are thimerasol free.
Below is a summary on vaccines issued by the American Academy of Pediatrics, and a short list of other helpful websites.
From the American Academy of Pediatrics
The AAP understands that parents may have concerns about vaccinating their children. Vaccines are one of the most successful medical advances of all time. Vaccine safety is an issue of great importance to the AAP and to pediatricians, who support ongoing research and increased funding in this area. In addition, the AAP supports further research into the causes of autism. The following information is to help parents and caregivers to understand some of the common issues and questions surrounding this topic.
What Is Autism?
Autism is not a specific disease, but rather a collection of disorders of brain development called “autism spectrum disorders,” or ASDs. Studies show that the prevalence of autism has risen. The apparent increase in autism may be due to a combination of factors. For example, more and more behaviors and disorders are being included in the definition of ASD than in the past. Also, the public and the medical profession recognize these disorders more often.
According to the Centers for Disease Control and Prevention (CDC), about 1 in 150 children have an ASD. Although many theories have been discussed, the cause or causes of autism are not known. Autism has a strong genetic basis. Currently about 10 percent of cases are connected with genetic conditions such as Fragile X or Prader-Willi syndromes. According to a January 2008 study, researchers have discovered another genetic mutation that could account for higher risk in another 1 percent of autism cases.
More research is being done every year to try to identify the causes and improve efforts to prevent, diagnose and treat ASDs. The nation’s top experts in pediatric neurology, genetics, and other fields are moving closer to answers about this group of disorders.
Early diagnosis is crucial. Pediatricians should screen all children for ASDs at 18 and 24 months. They should also listen carefully to parents about their child’s development. The AAP provides its members with comprehensive tools and education to assist them with both diagnosis and follow-up. Parents are the most reliable sources of information. When a child is diagnosed with an ASD, the child’s family and caregivers should be given information and support. The child should be involved in autism intervention programs as early as possible to get the most benefit.
What Is Mitochondrial Disease?
A recent case that was awarded compensation through the federal Vaccine Injury Compensation Program involved a child with a mitochondrial disorder or mitochondrial disease. This case has raised questions about what environmental triggers might bring on or worsen autism-like symptoms in children with such disorders.
Mitochondria produce the energy needed for cells to function normally. There are a number of genetic disorders that cause mitochondria to produce less energy than cells need. Symptoms of these disorders can be very mild or quite severe. In some of the disorders, symptoms do not develop for many years. Some of the rarer mitochondrial disorders affect the brain and cause worsening neurologic symptoms over time. In many cases, an event that requires more energy, such as an infection, fever or other illness, can lead to the development of symptoms.
Although details of the case and the decision cannot be disclosed by the U.S. Department of Health and Human Services, the agency published a statement on March 3, 2008, which said: “HRSA (the Health Resources and Services Administration) has reviewed the scientific information concerning the allegation that vaccines cause autism and has found no credible evidence to support the claim.”
According to the Centers for Disease Control and Prevention (CDC), this was a unique case and information about it has not been accurately characterized in the media and other public forums. It represents one special case and does not change the immunization recommendations for children in whom vaccines are otherwise recommended. More information is available at the CDC Web site: www.cdc.gov.
According to the United Mitochondrial Disease Foundation, “There are no scientific studies documenting that childhood vaccinations cause mitochondrial diseases or worsen mitochondrial disease symptoms. In the absence of scientific evidence, the UMDF cannot confirm any association between mitochondrial diseases and vaccines.”
What About Vaccine Safety?
Every physician is mandated to report adverse effects of vaccines to the Vaccine Adverse Event Reporting System (VAERS) so that the event may be studied further. Any adverse effects are acted upon immediately when there appears to be an association. For example, a Rotavirus vaccine that was found to be associated with an intestinal condition called intussusception was taken off of the market.
From time to time, rumors circulate that thimerosal, a mercury-based preservative once used in several vaccines (and still used in some flu vaccine), could contribute to ASDs. However, valid scientific studies have shown there is no link. The American Academy of Pediatrics (AAP), the American Medical Association (AMA), the CDC, and the Institute of Medicine (IOM) agree that science does not support a link between thimerosal in vaccines and autism.
Some parents are concerned about “combination” vaccines, which protect against more than one disease with a single shot. For example, the MMR vaccine protects against measles, mumps and rubella. These vaccines have been studied carefully and found to be safe. All vaccines contain antigens, which cause the immune system to do its work to fight (and protect the body from) infections. It is important to remember that children are exposed to many antigens during normal activities, such as playing outside or eating food, or when sick with an infection. Healthy children’s immune systems are equipped to handle these multiple exposures.
Why Are Vaccines Important?
It is most important that parents and pediatricians continue to rely on immunizations to protect all children from preventable—and potentially deadly—illnesses. Many vaccine-preventable diseases can have dangerous consequences, including seizures, brain damage, blindness, and even death. These diseases still exist even though many young parents today have never seen a case, due to the success of the nation’s current immunization program. Death and harm from chickenpox, measles, meningitis and other diseases are still a threat to children who are not protected.
Some specifics: Before HIB vaccine became available, there were approximately 20,000 cases annually. HIB was the most common cause of bacterial meningitis in children in the U.S. HIB meningitis once killed 600 children each year in this country, and those who survived often had deafness, seizures and/or mental retardation.
Measles is another example of a vaccine-preventable disease with serious consequences. Currently in the U.S., up to 20 percent of people with measles are hospitalized. This is one of the most infectious diseases in the world; if vaccinations were stopped, each year about 2.7 million deaths from measles worldwide could be expected. A recent outbreak of measles in San Diego, California, 11 children contracted measles and none had been vaccinated. This is the highest number of measles cases San Diego has seen in 17 years. It is believed to have started with a child who caught measles in Switzerland and then returned to the U.S. Likewise, it would only take one case of polio from another country to bring the disease back to the U.S. if people are not protected by vaccination.
In order for vaccines to protect everyone, an estimated 85 to 95 percent of the population must be immunized. Studies have shown that children who are not immunized are more likely to become infected with measles and pertussis. Younger children often are the most vulnerable; 90 percent of deaths from pertussis are in infants younger than 6 months old.
It is not advisable to skip or delay vaccines, as this will leave the child vulnerable to disease for a longer period of time. Parents should follow the immunization schedule provided by the CDC and its Advisory Committee on Immunization Practices, the AAP, and the American Academy of Family Physicians (AAFP) each year. This schedule is designed by experts to ensure maximum protection and safety for children at various ages. Parents should discuss any concerns with their child’s pediatrician. Serious events occur more often from the actual infection or disease, rather than from the vaccine; therefore, the vaccine is much safer.
For more information on vaccinations, here are some helpful resources:
www.aap.org
www.cispimmunize.org
www.cdc.gov
www.vaccinateyourbaby.org
For a look at my recommended vaccination schedule, please click here.
Although I respect fully the parents decision to ultimately decide on which vaccines to give, the group of pediatricians have all agreed that is is too risky, especially after recent outbreaks of measles and pertussis in NYC, to care for patients that are sure they are going to receive zero vaccines. Parents with newborns in the waiting room can't be exposed to whooping cough or measles, and although I would rather see your family than not see you, I unfortunately can't work with families who will remain completely unvaccinated.