So, you all know that John consideres me to be a bit of a "hippie" when it comes to parenting. Natural childbirth, cl
oth diapers, breast feeding,
EC,
a minimalist approach to "stuff" (although, of course,
not AP)... I will admit that I tend to be the one who brings these subjects up, and I tend to have a stronger opinion about these things than John does. I am guessing it is because I am the one who spends more hands-on time with our children and I definitly spend more hands-on time with other people's children than he does, so I tend to observe more parenting choices and techniques than he does. And form opinions about them.
But vaccinations are an issue where John has tended to lead the discussion and have stronger opinions. This is partially because he has worked in vaccine development (he worked on the HPV vaccine), partially because he had a severe reaction to a vaccine as a child, and partially because his brain is much more attuned to statistics, facts, figures, research and all the "science" behind vaccines. He truly has a brilliant mind and I admire and appreciate his abilities to comprehend and translate complex medical/science gibberish.
Let me start by saying that both of our children are fully up-to-date on their vaccines. John and I are up-to-date on our vaccines (a necessity in the field of health care if you want to have a job!), and Abigail and I have both received
additional vaccines for travel outside the US (John has, too, but I am not sure which ones since he traveled to different places that Africa.) My girls got their flu vaccines earlier this week, and John and I were supposed to get ours on Monday, but the vaccine clinic was cancelled.
We are not anti-vaccine by any stretch of the imagination.In terms of the actual vaccines, John and I feel that these have been well-researched and are as safe as any other medication you may give your child (unless you have certain risk factors that would increase your liklihood of a reaction to a vaccine, of course.) I know several people who feel that vaccines are "unsafe" or "under-researched," and I am not sure where these thoughts come from in the modern day of vaccinations. Sure, vaccines used to be a lot less safe than they are now, but the whole of medicine used to be a lot less safe than it is now. Technology has improved and so have our testing methods and ability to ensure safety and efficacy with medications and immunizations. I mean, we used to have only ONE antibiotic available, and it was a drug that had a high rate of patients with an allergy to it!
We also recognize the importance of immunizing against "outdated" or "old-fashioned" diseases. For instance, we have not had "naturally occuring" polio in this country in my lifetime (although we have had "imported" polio, and prior to the change-over to inactivated polio vaccines, there were rare vaccine-associated cases). Does that mean that we should not continue to vaccinate against polio in this country? John and I feel that would be foolishness, for 2 reasons. First, we can look at the UK and see that when you stop vaccinating against polio, it will be less than 10 years before you have a polio outbreak (and that is in a country with a much smaller population and lower risk of "imported" polio than the US... it would probably take much less time to experience an outbreak in US.) Secondly, we recognize that our children will probably travel to places where there is active polio, and their risk of exposure will be higher-than-average. Why would we not want to protect our children, especially in an increasingly "global" world?
I will speak to the multiple "side effects" of vaccines, because I have heard some people state that they feel the vaccine is not "worth the risk" of all the reported side effects. The first thing to know is that when testing a drug or vaccine of any kind, anything that the patient experiences within a given time frame of receiving the drug/vaccine must be reported as a potential side effect. So, let's say you get your flu vaccine, and 2 days later your develop a migraine. You have a history of migraines, so you may have developed that migraine even if you didn't get your flu shot. But, because it is within the "reportable" time frame, migraine now becomes a "potential side effect" of the flu shot. The phrase "side effects may include" means that someone, sometime experienced that side effect after receiving a drug/immunization, but it does not mean that the drug/immunization necessarily caused the side effect. In fact, in most cases, the rate of occurence of these potential side effects is no higher in the post-medicated population than it would be in the non-medicated population. That's why there is a difference between "common side effects" and "other side effects." And when you look at the "common side effects" of most vaccines, you end up with things like redness, itching, or soreness at injection site (duh) or general malaise (as is likely to occur when you rev up your body's immune system, which is what a vaccine is doing.)
We do not belive that there is sufficient evidence to support the idea that any individual vaccine causes autism or any of the other stories you hear in the news. Again, there are certain vaccines that are known to have higher rates of certain side effects, but we still feel the vaccines themselves are generally safe.
There are certainly situations where your personal health history makes the risk of side effects higher, and in some cases, will prevent you from receiving a vaccine. John had a severe reaction to the pertussis vaccine when he was a child, and given the familial propensity for allergies, we are concerned about this vaccine. However, the vaccine has been changed since John was a child, so we are willing to try the vaccine, knowing that we will be on "high alert" for potential reactions. It should go without saying that we believe your individual and family health history must always be considered when making choices about your health.
However, there is a huge difference between personal health and public health choices. For instance, John generally feels like crap for a few days after receiving his flu shot. In fact, in years past, he has decided to skip the flu shot (it is not mandatory for health care workers.) However, he also realizes that he is in a position of caring for people who are at high risk for the worst possible outcomes of the flu (the elderly, and now an infant at home.) So he feels it is in the interest of the public's health that he be vaccinated. Even if I didn't have a baby or children to think about, I would still receive my flu shot because I not only want to protect myself so that I can take care of my family, but I also want to protect the patients/families that I take care of at work. I know both John and I will have higher-than-normal rates of exposure to the flu (it's the nature of being a bedside health care worker) and we feel that we have an obligation to the public to do what we can to protect them. This also includes things like being vigilant in hand-washing, isolating ourselves if we think we may have been exposed/are sick, and enforcing visitation rules that limit the number of visitors that sick people receive. It's not for our benefit (although we will benefit)... it's for the benefit of public health.
I feel that we can no longer count on "herd immunity" in our country. There are enough people who have chosen not to receive vaccines or give them to their children, who have immigrated and did not receive vaccines, who have not been able to afford or have access to vaccines, or who have not been able to complete the vaccines according to the recommended schedule/booster schedule (and therefore do not likely have immunity) to count on "herd immunity" to offer protection to the individual or the public.
When it comes to vaccines and the vaccine schedule, I feel that the protection of public health is the general guideline in the development of the vaccine schedule, with the protection of the individual's health being the deciding factor in timing. What do I mean by that? Well, why do we vaccinate children against rubella? Is it because the kids are likely to experince a severe or fatal illness if they contract rubella? No- rubella itself is usually a mild, flu-like illness in children. However, the risk to an unborn baby whose mother contracts rubella before the 20th week of pregnancy are severe and can be fatal. And who is likely to be carrying these unborn babies? Probably the mothers and caregivers of the 2 year olds who have (hopefully) been vaccinated against rubella! This is is placing public health ahead of individual health, in a way.
Similarly, I believe we need to weigh the cost of vaccinations against the cost of illness. Rotavirus is a good example. The rotavirus vaccine is a relatively inexpensive oral vaccine that has been shown to prevent 85-98% of severe rotavirus illnesses. A severe rotavirus illness (Abigail had a moderate case) can lead to hospitalization (usually for dehydration) and can even be fatal (in fact, globally, rotavirus causes more than half a million deaths in children annually.) The cost of treating rotavirus is high, especially if it is a moderate to severe infection. Is it better for my child to receive the inexpensive oral vaccine than to have to be hosptialized for a severe rotavirus infection? Is it a better use of health care dollars/insurance reimbursement and health care resources to vaccinate my baby than to take up a hosptial bed for a rotavirus infection... to take away a hosptial bed from a child who has another severe illness? In my opinion, yes, it is better. It is part of being responsible with the limited health care resources we have in the US. So that is part of the public health vs. individual health equation, too.
The second point I want to make is that we have not read Dr. Sears' vaccine book. This is primarily because the excerpts I have read seem to be full of a lot of opinion, not full of a lot of fact, and written in a way that is purposely inflamatory. I have a doctor for a husband, and I would wager that John is actually smarter than Dr. Sears (John is smarter than most anyone, if I do say so), and I would rather listen to his opinions than Dr. Sears' opinions. Also, with his background in biomedical engineering and his extensive research work, John's understanding and ability to evaluate the authority and significance of research surrounding vaccines is probably significantly more developed than that of any of the Dr. Searses, based on their credentials. Meaning, I trust John more. Plus, I know he is not making any statements or giving any opinions for the purpose of selling books and making money. He is doing it because it is what he feels is best for our baby.
Now, I've told you that we feel the vaccines are safe, we feel they are important for personal and public health, and we are not basing our concerns on the work of others. So, what are our concerns? Why are we concerned at all?
Our greatest concerns regarding childhood immunizations is the
immunization schedule. By this, I do not mean the guidelines that say "give the first dose now, give the second dose in 6-8 weeks, and the third dose in 12 weeks" or what I would call the "
administration guidelines." I mean the standard schedule of giving several multi-organism vaccinations at one well-child visit. Let's be honest: the reason we developed multi-organism vaccines (where we vaccinate against multiple diseases with just one shot) was to increase compliance with vaccinations by decreasing the number of shots (and the subsequent discomfort to babies/parents). I mean, you can currently vaccinate against something like 9 illnesses with just 3 shots! That is certainly more palatable to parents than needing 9 shots to vaccinate against 9 illnesses. Similarly, the reason we give 2 or 3 or 4 shots at one well-child visit has a lot to do with increasing compliance with vaccinations. The parents and baby are already there, they don't have to come back at a different time to get the shots, and they will be coming back to receive the follow-up doses with their next well-child visits, so it seems like the perfect solution, right? Basically, the timing of immunizations has been molded to the timing of well-child visits (or is it the other way around?) And this is done to make it easier for parents- go get all the immunizations in, at the right administration guidelines, with minimal effort on the parents' part. As a busy mom, I can appreciate that... but our question is not whether this is easier, our question is if this is best for our baby.
Our concerns lie mainly in the fact that there is basically no research that shows that it is safe to "rev up" a baby's immune system to such heights (making antibodies for 9 illnesses all at the same time, not to mention whatever else baby has been exposed to during the course of the last few days/weeks). There is no research that shows it is unsafe, but there is no research that says it is safe. With the growing number of autoimmune and neurologic diseases that are observed and diagnosed at higher-than-ever rates amongst American children, we have an obligation to ask where that change has come from, and if our best efforts to protect our children could actually be harmful in some way. In areas where there are fewer vaccines available to children, are we seeing similar increases in autoimmune and neurologic disorders? The
NHS standard immunization schedule (used in the UK) includes a "5-in-1" vaccine, but has fewer overall vaccines than our schedule... what are the ramifications of that?
Australia's vaccine schedule is almost identical to our own... do they show identical increases in autoimmune and neurologic disorders?
India vaccinates against far fewer diseases... what are we seeing there? Does the age at which vaccinations start have long-term implications? Did you know that Germany's vaccine schedule is almost the same as ours, but vaccinations are not compulsary, so only about 66% of children get the 2 doses of MMR (which led to an outbreak of measles), but they have half the rate of asthma as the US? We are not saying we think the vaccination schedule is unsafe... but we are saying that we just don't know the full ramifications of the schedule. It needs to be studied. (
Canada's schedule, a comparison of
EU countries various TDaP schedules, scroll all the way down...)
John and I have decided to approach immunizing our baby with the goal of following the "
administration guidelines" without following the standard schedule our pediatrician uses. In order to do this, we have decided to break up some combination shots into individual vaccines and to make multiple visits to the office for the vaccines. Our goal is to introduce no more than 3 antigens at a time. Why 3? No reason other than this seemed logical and allowed us to consistently meet the administration schedule without visiting the doctor weekly. We are splitting out the DTaP from the Pediatrix (which includes IPV and Hep B) in an attempt to monitor for a reaction to the pertussis component (we wanted to split it out more, and give the Acellular Pertussis alone, but that is not available.) We are going in 2 weeks after a round of immunizations to get additional immunizations. We are prioritizing the vaccines our child will receive (giving the pneumococcal vaccine in earlier months and the IPV in later infancy) to meet the guidelines while limiting the number of antigens we introduce at one time and to get our child the protection that is most important given the fact that the Nugget will be attending day care and has 2 older school/pre-school aged siblings. Most importantly, we are using our best judgement and working with our pediatrician to make the best decisions for our family.
This is what we are
doing.
Again, this is what is right for our family based on our research and our goals for our kids. We are not suggesting that this is what you should do. But I hope that as you consider vaccinating your children, you not be swayed by the media or popular authors, but by facts, logic, and research.
