Tuesday, August 26, 2008

A Middle Ground

One of our readers saw the article, "Strife over shots, should our kids play together?" on the front page of msnbc. This article follows another similar article, "Vaccine-wary parents spark public health worry." According to the first piece, the vaccine issue is now causing such heated emotions and debates that some playgroups are asking unvaccinated children to leave the group. The second article provides a bit more background information and a nice overview of the debate.

The vaccine topic has been a regular discussion in our household. Yet unlike many of the mothers interviewed for these articles, we have followed a more middle-of-the-road approach to vaccinations. Both sides seem to be full of propaganda, fear mongering, and catch-all one liners. Throughout the past 4 years, I have been at my wits end trying to discern what is true and what isn't, trying to make the best health decisions for our children and family.

First, I have a hard time trusting anti-vaccine advocates, many of whom are very individualistic in their thinking and indifferent to herd immunity.
Scientists worry that vaccine resisters increasingly are breaching "herd immunity," the necessary level of protection that keeps disease from spreading. When enough people in a community are immune to a disease, they provide a buffer that keeps germs from infecting those too vulnerable for vaccination, or those for whom a vaccine doesn't work or wears off.

Some diseases, such as mumps, can tolerate a herd immunity threshold as low as 75 percent. But other, more virulent diseases, such as measles or pertussis, also known as whooping cough, require collective immunity of up to 94 percent to avoid infection, according to the federal Centers for Disease Control and Prevention. (emphasis added)

It is a fact that when we choose not to vaccinate, we are putting the community at risk. A small risk, but the risk grows with each family that makes this choice. This fact is often neglected by anti-vaccine advocates, and even if they acknowledge it, they claim that catching these diseases isn't such a bad thing. For some measles cases this may be true, but what about other diseases like rubella--which can actually kill or permanently disable an unborn child? Even the Church (CDF) has emphasized the dangers of contracting rubella and not vaccinating against it. (See my previous blog post on vaccines.) And what about those vulnerable members of our community that are immune suppressed? Isn't there any ethical duty to care about the herd?

On the other hand, I don't trust the pharmaceutical industry, and sadly, I don't always trust my doctors, who regularly try to downplay the negative individual side effects of vaccines:
The federal Vaccine Adverse Event Reporting System, a voluntary program that records bad reactions to immunizations, receives about 30,000 reports a year, with between 10 percent and 15 percent classified as serious, according to the CDC. Though rare, severe problems can occur, including serious allergic reactions, long-term seizures, coma or permanent brain damage.

That is at least 300-350 serious vaccine side effects per year. While small, this number is much higher than the number of children coming down with measles or whooping cough. In addition, both measles and whooping cough will result in a full recovery for most children. Sadly, this isn't the case for a child with a serious adverse vaccine reaction. It is important to remember that our government has set up a national vaccine compensation system for those families injured by vaccines.

Combine these reactions with the feared, although unproven risks of disorders like asthma, attention deficit disorder, autism, diabetes, and childhood cancers, and a parent begins to worry that a shot may cause more problems than the initial sting from the needle. Are we trading measles for autism? There is no scientific proof, but my mother's gut is loudly telling me that it isn't a good idea to inject a child with 32 different immunizations before the age of 2 (the standard number of immunizations including boosters).

It's a hard call, and each parent's decision will no doubt be influenced by such things as the following: previous vaccine reactions (like most things these run in families), individual health issues, your child care scenario, and even your doctor.

In our particular case, I am most concerned with the very aggressive nature of the typical vaccine schedule. A child may receive vaccinations for up to 12 different diseases at one appointment. If my child suffers a reaction, how do I even know what shot caused the problem? This and other concerns led us to adopt the following plan.

We delay all vaccines until 4 months. We then vaccinate one shot at a time, delaying some shots until our children are older than 2. Some vaccines we choose to avoid altogether because they don't seem worth the risk, examples of this include Hepititis B (sexually transmitted), Hepititis A, flu shots (many of which still contain mercury), and chicken pox (posing ethical issues, see my previous post). My children receive DPTa, MMR, HIB, Polio, and Prevnar.

I have worked out this alternative vaccine schedule with my pediatrician. I would highly recommend that all families find a pediatrician that is willing to listen to your vaccine concerns, address those concerns, and then work with you on a vaccine schedule that suits your individual needs. Far too many pediatricians REFUSE to listen to parent concerns, and then dismiss a parent as ill-informed or unintelligent when they have questions. Balancing the needs of the herd with the needs of individual patients is crucial here. I had to shop around for a pediatrician that would do this, and I am very pleased I took the time to do so. I know this isn't always possible for every family, but it makes a big difference when making such difficult decisions. My doctor is willing to discuss the issue, call me back at home to answer questions, and is VERY respectful when I let him know I am uncomfortable with the regular vaccination schedule.

In the end, I don't think there is a right answer for every child or family. I'm not a doctor, just a mom. A mom who has done her research and is trying to find a middle ground as I make informed decisions about the health of my children. Ultimately, I think it is a real shame that we have two opposing sides that can't give us the facts without a serious spin. It is my hope that someday the medical community will at least entertain a more cautious approach to vaccine administration.


Joanne said...

How many children would get whooping cough or measles if they all weren't vaccinated, though? It seems like the numbers of who would get whooping cough and who would get side effects are skewed because, in fact, most DO get the vaccinations. For now, anyway.

The way I see it, I chose my children's pediatrician because I think he is a person who cares about the health of my children. I don't think that he would give them vaccines for any other reason except to keep them healthy. I don't buy into the hype that the pharmaceutical companies and my doctor have gotten together to give my children medicine they don't need in order to make a profit. We go to our pediatrician for medical care that I can't provide. I have no reason to go in and start telling him how to give my children vaccinations, my kids have never had any side effects from the vaccinations. It seems beyond self serving for me to go in and tell him that because another child had a reaction, he should give my child vaccinations on that child's schedule. It just doesn't make sense, to me.

Elena said...

Red, thank you for this post on vaccinations. I appreciated your last one as well. I followed the routine vaccination schedule for my first three children but have slowed down the schedule significantly for our fourth child. He is nine months old and has only just completed his four-month needles. We have opted for such a schedule because of worry over reactions. He has always been more 'sensitive' than the others particularly when it comes to his gut. I was worried that too many vaccines too soon could send that little gut over the edge. He reacted quite badly (change of behaviour) to his first shots and this signalled to us that we needed to slow down. At first, I wanted to throw out vaccinations altogether but, like you, I realised that this wouldn't be responsible to our child or our community. It can be very scary to alter from standard medical procedures, schedules etc. but, thank God, we have a doctor who understood and recommended a much slower vaccination schedule. Our child also receives daily doses of cod liver oil that prepare him for the introduction of vaccines. I trust the medical establishment but I also realise that I need to be as informed as possible before going to the doctor. Part of being informed is prayer and trusting the feminine intuition that we call our gut instinct.

Kat said...

Red, thank you so much for putting together this very informative post - I really appreciate how you synthesize such a large amount of information into a very digest-able post! We have decided to follow the normal vaccination schedule for our children, and I try to pay close attention to my children's reactions to their shots. If I were to notice a change in personality beyond just the normal fussiness for a couple of days, then I would alert my pediatrician and make some changes. Partly, our choice is because our family does not have a history of being sensitive to any foods, medicines, or other environmental factors, so I don't have reason to believe that our children would be adversely affected by vaccines. Another part of the equation is that it is both ET and my personality to trust our doctors and to follow their advice. This doesn't mean that I don't do my research or follow my gut, because I certainly do; but it does mean that I'm less likely to question than others.

Juris Mater said...

Red--I really, really appreciate your "middle ground" recommendation of just delaying most shots, not foregoing them altogether or requesting a totally abnormal vaccine schedule to harass the kind pediatricians. I think simply delaying until the next appointment is a pretty manageable request for most pediatricians, and it sounds like it's not a health risk as long as babies are starting vaccines by 4 months or so. And I totally agree with no Hepatitis B for 1 day old babies, or any babies for that matter--that's just nasty (I understand there's a minute chance of contracting Hepatitis B from a blood tranfusion, but still...).

Mary Alice said...

Thanks Red, this is a good starting point for me to think about this issue. Up until now I have decided that I cannot obsess about everything and so I have pushed this issue aside, but I am about to go to a big group pediatric practice, I have chosen it for convenience, it is close to home, the docs are really nice, great with the kids, the waiting room is large and comfortable, these things matter to me when I have to get 5 kids there on a regular basis, but it is a bit of a factory and I think they do give a lot of shots at one visit since the well visits seem fairly spread out.

I previously lived in a town that saw live measles cases on a regular basis (not sure why, major international airport nearby?) -- you literally could not find a practice in that town that would allow you not to immunize, but my doc, an osteopath, did use a slightly delayed schedule with more frequent well visits (monthly) so that the shots could be spread out a bit. He also told me that he was not giving certain vaccines because he was not yet convinced by the data -- I was more trustful of him becuase he showed that he was considering it all.

Joanne, I think it is great that you feel that way about your doctor, I just don't think that is true in every case. It is not that I think they are in league with the pharmaceuticals, but I think that hospitals and some doctors have practices that are more tied to either liability or community health practices for the lowest common denominator.

For example, why is my OB practice asking me to have an extra HIV screening at 28 weeks?

Anonymous said...

Speaking about what might cause autism, has anyone read about the link between TV watching and autism? http://www.slate.com/id/2151538/ Our children don't watch much TV, but we imposed a TV moratorium for a month and noticed significant improvement in behavior in our 3 yr. old. -- happier, less whiny, etc. Amazing!

Anonymous said...

Just a thought-from the medical perspective, the doctor who did the original study linking vaccines with autism and other developmental consequences has been heavily criticized because of the paucity of research and lack of evidence, as well as the small size of the study and lack of blinding. The 12 children who he based his study had complicated medical and developmental issues prior to the administration of the vaccine.
Although I agree that serious reactions can occur with vaccines, it is also important to remember that just as serious reactions can occur from these seemingly benign childhood illness-fatal encephalitis, myocarditis, and if a pregnant woman is exposed, death to her fetus from measles, and hospitalizations from whooping cough used to be common, especially in the young babies.
I think it is important to be well informed concerning childhood vaccines, but it is also important to keep in mind that these illnesses are thought to be dangerous enough to necessitate vaccinations, mostly for good reasons.
This is not meant to scare in either direction, but rather to encourage good, hard looks at which research backs which side and looking carefully at the reasoning behind the decisions concerning vaccines.
Also, the reason you were screened at 28 weeks for HIV is that it is better to screen everyone and catch a few cases of undiagnosed HIV than to screen only those who ask and risk missing HIV diagnosis. The medicine is so good at preventing transmission from mom to baby that to miss this in anyone would be a tragedy.

Erin said...

I loved this post and it is an issue we have been researching for a couple years now. My second daughter is nine months and after doing all the vaccinations right on schedule for the first, we stopped at 2 months with the second....for lots of reasons. I echo most of what this post discussed. We have chosen to wait a few months to start any shots to give the immune system a chance to boost itself up, especially since I breastfeed. Then we will follow an alternative schedule (never more than one AL containing shot at a time) and only two max to know what the reactions are from if any. I don't mind brining my child back more often to get shots...which is the main reason doctors have created COMBO shots and so many at once, for convenience!!! Really loved all the research and reading we did on this subject....and glad I can now answer the questions my doctors couldn't when I asked them!! Here is a link to a paper of my notes I did on the subject a few weeks ago...two of the main things I really learned as well are...that AL is in so many of these shots and has complivation...I think AL is going to eb the next mercury...and in time taken out of vaccines. Second, learning exactly what is in the vaccinations and also the different BRANDS of each vaccination. For some, one brand is three times as "worse" as the other brand for the SAME vaccine...for example contains almost 3 times as much AL. Defintely will be discussing with my doctor the brands I want my children to receive. Here is the link: http://www.hartsellhouse.com/2008/07/informed-decisions.html
thanks for addressing issues like this!!

Erin said...

A good site is:
Has some great info about the moral choices and standings of the church and also news to look out for and keep up to date with. Interesting research and suggestions concering the MMR shot and the rubella factor. Since it still uses fetal stem cell line, I hesitate with this especially since the diseases are not that bad. And the rubella...the woman gets tested at her first OB appointment for immunity and can make changes then....interesting food for thought...mroe details on site.

Right Said Red said...


I have had a similar experience to MA in that I don't always have the best relationship with my docs. I was tested for HIV, even after I specifically declined my consent. I was laughed at for using NFP, laughed at for giving my children organic milk, and I was even advised to abort my 1st baby due to a poor prenatal diagnosis.

These experiences have made me somewhat skeptical of the medical community. I do really like my children's pediatrician, but if I blindly did whatever he suggested, I would feel as if I had failed as an advocate for my child.


Thanks for the links.

All our other readers,

I wish you the best as you try to navigate this issue for your families!

Joanne said...

I have certainly had similar experiences with other doctors, specifically my OB. I go to a kind of rough, city hospital, where I feel like I'm treated like an idiot in most cases. I have to be offered birth control options every SECOND that I am pregnant or in the hospital after giving birth, prenatal testing is offered every other minute, it's ridiculous. My son is autistic, and just yesterday, we saw a developmental pediatrician who told us that we should see a geneticist so that we could find out what the chances are of us having another autistic child. Although I liked lots of other things about him, I was very distressed to hear that recommendation. I thought, why would I have that testing? So that I don't have another child like my son? Who I love and consider as much a gift from God as my non- autistic daughter? Living in such a anti-life, anti-child, anti-Catholic world can be very distressing indeed, especially for an 'elderly' first time mother like myself, so I definitely hear what you all are saying about the medical community and testing. But as far as vaccinations go, protecting my children from diseases that have been eradicated but might come back because people with bad information are making decisions they shouldn't (not that that is what you all are talking about) is very different, in my opinion. I literally could not find a pro-life doctor in my city, and the Catholic hospitals here are a joke, as far as birth control is considered - I found it to be shoved down my throat there the same as at the public hospital. But I have found that, for me, by making it a priority, I have found a doctor for my children that I can completely trust and I wish it for all of you, too.

Amanda said...

Thanks Red for another great post. I have found it hard to navigate this vaccine jungle as well because of the very strong views from both sides of the issue. I hope for each parent that they are able to do the research and make an informed decision that is right for their family. But I also sometimes wish that some of those same parents could also just respect the decisions others have made for their families as well! How right you are in identifying both sides in the fear mongering. I have faced the mom who cannot comprehend why if I am going to vaccinate, why I wouldn't just do it according to a schedule set for every child instead of a modified schedule set up for my child, and the anti-vaccine mom who either blatantly or in a veiled way makes me feel like I am intentionally hurting my son by vaccinating at all. Yikes - mommy guilt is bad enough without other moms judging. So yes, I couldn't agree more that it is up to every mom to do their research and make an informed decision, whatever that decision may be.