Making an Educated Decision for Your Children
Robert Sears, MD, FAAP
Dana Point CA USA
From NEW BEGINNINGS, Vol. 25, No. 1, January-February 2008, pp. 4-9
Every parent today has questions about vaccines. Are they safe? Is there still mercury in some? What are the potential side effects? Can I delay some shots? Are all the diseases still common? Do vaccines cause autism? You want to know the answers before your baby's first checkup and shots, but you have nowhere to turn for unbiased advice. Your doctor tells you that all vaccines are perfectly safe, that the diseases could kill your child, and that you have to vaccinate or else you are putting your child, and everyone else in the country, at risk.
On the other hand, the anti-vaccine books, Web sites, and some of your friends tell you that vaccines are dangerous, the diseases are harmless, and that you are crazy to vaccinate. Wise mothers are making a commitment to breastfeed for at least one to two years in order to decrease their baby's risk of catching these diseases, yet even the extraordinary immune benefits of breastfeeding aren't a 100 percent guarantee against illness. All these uncertainties lead to the one all-consuming question of the decade that every parent agonizes over: "Should I vaccinate my child?"
Fourteen years ago, with the birth of my first child, I wondered the same thing. I was a budding young medical student with access to a large medical school library (the Internet wasn't around yet) and I jumped right into studying every article I could about vaccines. That began my 14-year journey of research and discovery that has culminated in The Vaccine Book. Did I actually find an exact answer to this question? Yes. But it's an answer that is different for every family. And it's something that I can't answer for you; you have to educate yourself in order to come up with your own individual answer. I wish I could make it easy and simply say yes or no to vaccinations. You'd be able to stop reading, breathe a sigh of relief, and move on, question answered. But parents are smarter than that. You don't just want the final answer...you want to know how to arrive at that answer, and why.
In this article, I'm going to share with you some of the questions I asked myself, the answers that I found, and what I've learned from parents, medical research, and colleagues over the years. I hope at the end of these few pages you'll feel more equipped to make an educated decision for your child.
Knowing what to do with your child's vaccines begins with a clear understanding of the diseases they prevent. Here is a brief overview of each vaccine-preventable disease.
HIB: This very serious bacteria causes meningitis and bloodstream infections. It is now a fairly rare disease (thanks to vaccination), and occurs mainly in infants and the elderly.
Pneumococcal Disease: This very common bacteria causes anything from a mild cold, cough, or ear infection, to serious pneumonia, bloodstream infection, and meningitis. Like HIB, most serious cases and fatalities occur in infants and the elderly.
Diphtheria: This is a very severe throat and upper lung infection with a high fatality rate. It is virtually eradicated from the US. Tetanus: This germ festers in deep dirty wounds and causes weakness and temporary paralysis. It is rare, and virtually all cases in the US occur in adults.
Pertussis (whooping cough): This is a very common and severe coughing disease that affects all ages. Virtually all fatalities occur in infants six months and younger.
Hepatitis B: This disease, which is transmitted sexually or by other modes of blood exposure, causes liver damage. It is most serious when contracted during infancy or childhood, but virtually all cases occur in adults.
Rotavirus: This virus causes severe diarrhea, vomiting, and dehydration and can be fatal during infancy. It is less troublesome after age one and most children catch it at least once.
Polio: This virus causes weakness and paralysis and is potentially fatal. Fortunately we haven't had a case of naturally occurring polio in the United States in over 20 years. It has been eradicated from the entire Western hemisphere and only occurs in parts of Africa and Asia.
Measles: This fever and rash disease is now very rare in the US. Fatalities are almost unheard of, but occasional organ damage can occur. Mumps: This virus is usually harmless in children, but in teens and adults can cause some organ damage and complications. It was fairly rare until a recent outbreak spread through the Midwest.
Rubella: This is a fairly harmless fever and rash illness, and it is now extremely rare in the US. It can cause birth defects if a pregnant mom catches it.
Chickenpox: This well-known virus causes a week of miserably itching spots. Fatalities are rare, but complications are more common for teens and adults.
Hepatitis A: This viral intestinal infection usually passes unnoticed in young children. Teens and adults will suffer through a week or two of severe intestinal flu symptoms. It is fairly common.
Flu: This most common vaccine-preventable disease is serious mainly in the elderly, and occasionally for infants. Fatalities do occur, but are far less common than the media hype would have you believe.
Meningococcal Disease: This bacteria causes a very severe bloodstream infection and meningitis and has a high fatality rate in all age groups. Fortunately, it isn't very common.
Human Papillomavirus (HPV): This sexually transmitted virus causes genital warts and cervical cancer. It is extremely common, infecting most people who have had multiple sexual partners.
How does breastfeeding and choosing a stay-at-home lifestyle for a mom and her baby affect the risk of catching these diseases?
Breast milk provides babies with numerous antibodies that help protect against most diseases, both the common illnesses as well as the vaccine-preventable ones. Breastfeeding into the second or third year of life is a great way to protect a baby from illness. While this protection isn't perfect, and no one has ever figured out the exact statistical benefits for each disease, it certainly is worthwhile.
Keeping a baby out of group daycare and church or health club nurseries for the first year or two is another way to lower a baby's risk. Many vaccine-preventable illnesses are contracted in such settings. A stay-at-home baby, on the other hand, has a much lower risk.
When parents of a stay-at-home breastfed baby tell me they want to delay or decline vaccines, I worry a bit, but not too much, since I know this baby's risk is low. On the other hand, if a mom tells me she just weaned her two-month-old, is planning to put him into daycare next week, and she's thinking about skipping the vaccines, I cringe. This baby is virtually guaranteed to come across at least one serious vaccine-preventable disease. Such parents should strongly consider what I call "Dr. Bob's Selective Vaccine Schedule." This gives a baby the most important vaccines at the age when they are needed most.
What diseases are the most common and serious for infants?
Some diseases are very common, and some are rare. Some are very serious, even life-threatening, and others are fairly mild. Obviously, a disease that is both common and potentially severe would be very important to vaccinate against. A disease that is mild and rare would be less so. In addition, some diseases are only serious during infancy, but not later on. Knowing at what age each disease poses the greatest risk is important as you decide when to administer each vaccine. The diseases that are serious mainly during infancy, but not beyond age two or three, are HIB, pneumococcal disease, pertussis, rotavirus, and the flu. All these diseases, except for HIB, are still very common, so vaccinating against these during infancy is fairly important.
What diseases are more serious and common for teens and adults?
The diseases that are fairly mild if contracted during young childhood, but become more serious for teens and adults, include chickenpox, measles, mumps, rubella, and hepatitis A. Diseases that virtually never occur in children, but do occur in teens and adults and are potentially serious, include hepatitis B, HPV, and tetanus.
What about diseases that are fairly mild or extremely rare? Are those worth vaccinating against?
This is one of the great debates between vaccine critics and proponents. The main reason we keep vaccinating against mild or rare diseases is to keep them that way. If we stop vaccinating against polio, for example, before it is eradicated from the world, the disease could begin spreading around the world again. We stopped vaccinating against smallpox in 1969 after it was wiped from the planet. (I was one of the last children to get that shot -- I have the shoulder scar to prove it!) Plus, even diseases that are usually mild will cause an occasional complication or fatality. If some of these rare or mild diseases run rampant though a country, more complications would occur.
How common are vaccine side effects? Are they worse than the diseases themselves?
We know that all vaccines can cause some side effects, such as fever, fussiness, pain and swelling, and various body aches. Such reactions are expected, and I consider them to be harmless in the long run, as long as they aren't too severe. But it's the more serious, life-threatening reactions that have most parents worried. How common are such events?
Data from the Centers for Disease Control shows that the likelihood of a severe vaccine reaction that results in a sudden, life-threatening event, a prolonged hospitalization, a permanent disability, or death, is about one in 100,000 doses. Children get about 39 vaccine doses over their childhood, so the risk of a severe reaction over the entire vaccine series is about one in 2,600. This doesn't count the hidden, long-term reactions, such as autism, that some people suspect are connected to vaccination (this claim is unsubstantiated). The reactions that have been fairly well documented and connected to vaccines include brain swelling and inflammation (encephalitis), brain dysfunction (encephalopathy), nerve dysfunction, organ damage, severe arthritis, auto-immune disorders, and other effects.
What about the risk of catching a severe or life-threatening case of a vaccine-preventable disease if you are unvaccinated?
This risk varies greatly among the various diseases. For some it is as rare as one in a million. For others it is a very high one in 100 risk. Grouping all vaccine-preventable diseases together, the risk of a severe case during the first 12 years of life is about one in 600.
It seems that statistically the diseases pose more risk than the vaccines. But if long-term problems, such as ADD, autism, and other chronic diseases, are ever proven to be associated with vaccines, then it's a whole different story. However, these problems have never been scientifically proven to be related to vaccines. So for now, I can't tell you how these risks may or may not factor into your vaccine decisions.
What are some of the legitimate worries about the current vaccine schedule?
There are many controversies concerning vaccines, but it's hard for parents to separate fact from fiction. There are countless rumors spreading on the Internet and so many unfounded criticisms that it's no wonder most parents are confused. I have spent years researching every issue and I would like to shed some light on some of the problems with the current vaccine schedule.
My first worry about vaccines is that babies can get as many as six simultaneous injections at each checkup at two, four, and six months of age. Although there's no definite proof that this is harmful, theoretically, exposure to the various chemical ingredients and germ components in all these vaccines may not be ideal for such small babies. What's my solution? My "Alternative Vaccine Schedule" spreads vaccines out, giving no more than two shots at each visit over a wider time span. I believe this allows babies to better process the chemicals in vaccines and it may help each vaccine work better.
One particular chemical in vaccines that I am most concerned about is aluminum. While this metal is harmless if ingested into the gastrointestinal system, when injected directly into the body it is toxic and damaging to the brain and bones. To avoid toxic reactions, the FDA carefully regulates the amount of aluminum that is allowed to be injected each day into hospitalized patients through IV solutions and medications. But vaccines are exempt from this limit. Aluminum is present in six of the childhood vaccines, four of which are given simultaneously at two, four, and six months. Depending on which brand of vaccines are used, a baby could get as much as 30 times the FDA's known safety limit of aluminum at each of these visits. Why is this allowed to happen? Well, it's the same problem that occurred when mercury was used as a preservative in vaccines. As more and more vaccines were added to the schedule, no one realized how much mercury or how much aluminum a baby might receive at one time. I hope to change that. This alternative schedule chooses vaccine brands with the lowest aluminum content and gives only one aluminum-containing vaccine at a time to allow a baby to better detoxify the aluminum.
Another worry that I have about giving so many shots at the same time is that this may trigger more adverse reactions than would happen with only one or two shots. Many babies react to each round of six shots with days of fussing and fever, signs that the vaccines are irritating the immune and nervous systems. In my practice, such reactions are fairly uncommon. When a baby does suffer a severe adverse reaction, it would be prudent not to repeat that vaccine again. But if six shots are given together, there's no way to know which one was the culprit that caused the serious reaction. Many doctors would likely just continue all the shots and hope for the best, instead of stopping all six suspected vaccines. With my schedule, it's easier to sort out which vaccines are causing severe reactions. Fortunately, such reactions are rare. That leads to another concern I have, and that is the lack of good long-term follow-up with vaccine test subjects to determine what, if any, long-term side effects may occur. Vaccines are tested on many tens of thousands of infants before they are released to the general public. But these infants are monitored for only about a month in most cases. No one tracks these babies for the next 10 years to compare their health to that of an unvaccinated control group. I know such research would be costly, but in my book (literally) it would be worth knowing what long-term problems with vaccines may be possible.
A common criticism, and one that I don't disagree with, is that there is no reason to give hepatitis B vaccine in newborns and young infants. Hepatitis B is a sexually transmitted disease. The only way to contract it is through contact with the blood of an infected person. Babies can catch it during the birth process from an infected mom. But unless a parent is a hepatitis B carrier, the likelihood that a baby will catch this disease is virtually zero. This vaccine also causes some considerable side effects in newborns. New research shows that this immunity against hepatitis B may wear off by age 15 when the vaccine is given during infancy. This means by the time a child actually needs hepatitis B protection, it will have worn off in some children. My schedule suggests giving this vaccine later on, after the more important shots are finished.
A final concern I want to mention is the continued use of mercury in some brands of the flu vaccine. This harmful metal has been removed from virtually all vaccines. The only ones that still contain significant amounts of mercury are two brands of the flu vaccine and the plain tetanus and the diphtheria-tetanus shots in the large 10-dose bottles (the small single-dose vials have the mercury filtered out). All other vaccines either don't use mercury at all in the manufacturing process, or the mercury is filtered out so that only minute traces are left in the vaccine (about one percent of the amount still found in some flu shots). Laws were passed in many states that banned the use of mercury in vaccines for infants, but these bans were put on hold last year when of the supply of mercury-free flu shots ran out. In my opinion, it's better not to get a flu shot at all if you can't find a mercury-free one. This is especially true for infants and pregnant women.
Are there some other unusual ingredients in vaccines that are risky?
Vaccines are made in a variety of ways using many different techniques. Some contain live viruses, some have killed germs, and some only have fragments of the germs. Most contain various chemicals, from formaldehyde to MSG. Some vaccines use animal or human body tissues or blood products during manufacturing. Some vaccines have genetically altered germs in them. The list goes on. While most of these items are generally regarded as safe, they haven't necessarily been researched in great detail. I worry that we don't know enough about the safety of every single vaccine ingredient. However, I also can't find many proven problems with vaccines and their ingredients.
One risk that is worth mentioning, however, is the use of human and animal tissues. Some vaccines in the past have been found to be contaminated with the SV-40 virus from the monkey tissues used in manufacturing. This virus is a known trigger for some types of cancer, and many millions of people were injected with it. Now we know not to use monkeys who carry this virus, but are there other unknown infectious agents we don't yet know about? Do we really know everything we should about the safety of animal and human tissues?
It's important that parents understand how each vaccine is made, what the ingredients are, how the various brands of each vaccine compare, and what ingredients may be risky so you can fully understand exactly what is in each shot you are choosing for your child.
Vaccines and autism -- is there a connection?
This has become the most controversial topic relating to vaccines today. With the continued rise in the incidence of this disorder, now affecting one in 150 children, everyone is searching frantically for a cause and a cure. There's no way to adequately cover this topic in just one paragraph, but I will summarize my own research. I believe there are many factors that all work together to trigger autism: genetic susceptibility to chemicals, exposure to such chemicals through pollution and diet, various intestinal infections and digestive problems, immune system abnormalities, allergic problems, and more. The suspected link to vaccines is described by some researchers as being due to mercury exposure (which is no longer much of a factor) combined with the live measles component of the MMR vaccine (which never even had mercury in it). The measles virus has been found to infect the intestines and brains of some autistic children, but it isn't known for sure whether or not this actually contributes to autism. Go to TheVaccineBook.com for more information and new developments as they occur in the autism debate.
What about delaying vaccines. Is that an option?
Anything is an option when it comes to vaccines. But parents need to make sure what they choose to do makes sense. A common recommendation among vaccine critics is to delay vaccines until a child is two years old. Theoretically this allows time for a child's immune and nervous systems to mature and handle the vaccines better. I haven't found enough research to prove or disprove this claim, so I can't say whether or not delaying vaccines is the right choice. But I would like to point out that some of the diseases we vaccinate against are only serious or mainly occur during the first year or two. So, if you wait until age two to vaccinate, it doesn't make sense to get all the vaccines. The way I see it is that infancy is when the diseases are the most risky and severe. So, parents should either vaccinate their babies during that time when the shots are most needed, or skip some of those vaccines altogether and move on to choosing only the vaccines that are needed to protect against any common or serious diseases that may occur during the rest of childhood. Exactly which vaccines you should choose for your older child isn't an easy question to answer, and explaining all the logic and details that go into such decisions is beyond the scope of this article. The bottom line is to get each vaccine at an appropriate age, so that your child is protected from the disease when it is most common and/or most risky.
Talking to your doctor about vaccines.
In the "old days," parents could simply go to their doctor, ask any question they wanted to, and get a complete answer that they could trust implicitly. Patients followed their doctor's advice without question because the doctor always knew best. Well, when it comes to vaccines, things have changed. Many parents are finding that their doctor just doesn't know the answers to many vaccine questions. I'm not trying to put down our noble profession, but doctors, myself included, receive very little training on the details of vaccines. We learn that the diseases are bad, and anything that prevents them, like vaccines, is good. If we want to learn more, we have to research it ourselves. Most doctors don't have the time; it took me years to learn what I know. Instead, doctors trust their medical boards and academies to do the research for them and advise them what to do. This is true for many areas of medicine. So don't blame your doctor if he or she can't answer your long list of vaccine questions.
If you want to have a long and complete conversation with your doctor about vaccines, I have a few suggestions. Don't wait until your baby's two-month checkup. Your doctor has probably only allotted about 10 to 15 minutes for your visit, which is just enough time to do the actual checkup. It takes a good 20 to 30 minutes more to have a thorough discussion about vaccines. If you surprise your doctor at the end of the visit with, "Oh, we're not sure about vaccines; we have a bunch of questions to ask," what kind of answer do you think you are going to get? Your doctor will likely spend the few minutes he has left telling you why vaccines are important, that your baby could die from one of the diseases, and you should begin vaccinating now.
A much better approach is to first educate yourself by reading a few books and articles on vaccines. Then make a separate appointment with your doctor when a checkup isn't even needed. Your doctor will feel less pressure to just give you "the party line" and will have time to openly and honestly answer your questions.
Some doctors, unfortunately, are so pro-vaccine that they will kick you out of their office for even asking. However, new guidelines from the American Academy of Pediatrics that were published in the 2006 Redbook of Infectious Diseases discourages this practice. The AAP suggests doctors take a non-judgmental approach, inform parents of the risks and benefits of each vaccine and disease, and develop a schedule that spreads out the vaccines if parents are uncomfortable with so many at once. If parents still decline vaccines, this decision should be respected (unless there is a current epidemic that puts the child's life at significant risk), and doctors should avoid dismissing parents from their practice solely on this basis. Since these guidelines are new, most doctors may not know about them yet.
Should you vaccinate your baby?
This is not a question I can answer for you in just one magazine article. I've tried to whet your appetite and give you some interesting ideas to ponder as you consider vaccines. I do feel vaccines are important, and I vaccinate most of my patients. But I do so using a safer schedule than the standard one most doctors follow. I also have patients whose parents choose to delay or decline shots.
I have written The Vaccine Book to give parents the information they need to know to make an educated decision for their children. I have also created TheVaccineBook.com as an interactive, blog-based Web site where parents can ask questions, discuss issues with other parents, and find a local doctor who feels comfortable with parents who want to vaccinate differently. I also plan to speak at as many La Leche League Conferences possible, so check your local Conference schedule, or watch my Web site for announcements on when and where I'll be speaking. I wish you all the best as you make your decision.
Editor's Note: Since Dr. Robert Sears practices in the United States, he focuses on vaccines from a US perspective. Many of the recommendations from the US government are similar to the recommendations in other countries.