Vaccines

3/13/2008

I’m sorry to say that vaccinations have become a lightning rod for some young parents and often a real point of friction with their pediatricians. Although vaccines have saved millions of lives in the last 50 years, some parents are still uneasy with the concept of exposing children to a virus or bacteria in order to protect them from greater harm.

I think the Internet is partly to blame for this conflict. While the Web can be a source of good solid scientific information on vaccines and their side effects (see below), it is also provides a forum for those opposed to vaccines, who are often a little sloppier with their science, either intentionally or through misunderstanding. And I strongly object to the idea floated at these sites that pediatricians are either in on a conspiracy to hide the truth about vaccines or are too unsophisticated to understand the dangers.

Why do I support the use of vaccines?

• They work. I’ve seen the serious diseases and the complications from minor diseases that vaccines prevent, and I can tell you that you don’t want your child to experience them. As a young physician and resident in training in the 1980’s, I regularly saw infants and toddlers suffer neurological impairment, blindness, deafness, and even death due to Haemophillus influenzae meningitis. When a vaccine was introduced in 1989, the disease virtually disappeared.
• They provide “herd immunity,” protecting not only the person getting the vaccine, but also the people around them who cannot get the vaccine, like pregnant women and people who are immune-compromised. At the same time, these serious infections find the unimmunized or those with low antibodies and attack the weakest of the “herd”.
• Serious side effects are very, very rare. No medical procedure is 100% safe, of course, but in all my years of practice, I have never seen a very serious side effect of an immunization. Years back when vaccines were less sophisticated, I did see many irritable babies with fever following the old DPT vaccine. Since the new acellular DPT vaccine was introduced, I rarely hear from a parent with a post vaccine reaction. Local reactions such as swelling in the area of the shot are quite common with these sophisticated acellular vaccines but these are not serious. That being said, there is always an extremely rare incidence of serious reaction following any vaccination. These are well documented over many years of experience with any immunization. Unfortunately there is currently no predictive way of knowing who is at risk for these extremely rare reactions. I repeat that I have never seen a child with one of those reactions over many years of practice.
• They are monitored for safety. No vaccine is ever free from scrutiny. All adverse events from vaccines are reported to the federal government and investigated. Today’s vaccines are monitored by a wide variety of agencies and other monitoring programs. A system of double and often triple checks are in place to ensure that no mistakes are made. Often rare side effects are only spotted when large enough numbers of people have used newly approved vaccines.

As a pediatrician I consider myself first and foremost an advocate for children. As an integrative pediatrician, I am only too happy to recommend safer, gentler, or more effective remedies when they are equal or superior to conventional treatments. But after 25 years as a pediatrician, my belief in the value of vaccination has only gotten stronger. Most integrative physicians and the leaders in the field agree. Unfortunately, the anti-vaccine groups are far more organized, vocal, and politically active than physicians are.

Let me tell you how pediatricians responded in the 1990s when suspicion arose that a rare but serious complication might be associated with the first FDA-approved vaccine against rotavirus. The new vaccine was, as usual, being monitored by federal agencies, large HMOs, professional medical organizations, and the vaccine manufacturers. However, once a California HMO reported an increase of cases of a serious gastrointestinal disorder in children receiving rotavirus vaccine, the American Academy of Pediatrics immediately notified all 60,000 pediatricians in the United States of the problem. I remember receiving multiple faxes that day, and instructing my nurse to stop administering the vaccine immediately, well before the eventual FDA recall. This is precisely what pediatricians do, we protect children. 

It is important not only to vaccinate our children, but also to maintain our own adult vaccination schedules. When we let our guard down, disease incidence goes up. Recently there were measles epidemics in England, Israel, Denmark and even a few cases in New York not far from my office. These epidemics were linked directly to vaccine refusers. As a result, there are now previously healthy children who are disabled from complications of the disease.

Recommended resources:
National Immunization Program, www.cdc.gov/vaccines/
Immunization Action Coalition, www.immunize.org