Vaccinations – dipping my toes in the waters

I have wanted to talk about vaccinations for a while, but I have been afraid to broach the subject. I am definitely at a clash between two cultures when it comes to vaccinations. I know how ugly the language can get coming from both sides of the issue. I want to discuss some nuance here. Let’s see if it works.

I got an email from a faculty member at my medical school asking us to make phone calls against Florida SB 242 relating to immunizations, which is on the agenda of the Policy and Steering Committee on Ways and Means April 21st. I am not taking a stand on whether this sort of email is appropriate. I do encourage political discourse. I wish the email had a link to the full text (pdf) of the bill (which is actually hard to pin down. I think there are a lot of proposed amendments, too) or used the original language of the bill. I would like to exercise my same freedom to discuss the issue that my faculty member took, and examine some aspects of the proposed legislation.

The proposal wants to start a registry of vaccines by lot number. Why is this a problem? I know many people swear there is no link between autism and vaccines. Vaccine reactions are supposed to be rare. Why can’t we support this by tracking lot numbers? Autism was not under any form of surveillance in Florida when I wanted to research it five years ago in an epidemiology class. There are supposed pockets of autism here. What’s wrong with a little old fashioned public health research here? Nothing wrong with data. The lot number is an easy enough thing to note. When I administer an HIV screen I note the lot number (with a sticker) in no less than eight places. Parents can refuse to be part of the registry. So, this doesn’t have to be a burden if parents are resistant to having that sort of information recorded. I am a big fan of opt out options. (Although I tend to think there will be some overlap between the parents who don’t want their kids’ vaccines tracked by big brother and the parents who don’t want to vaccinate, period.)

The second recommendation (one of the links above) is to prohibit:

The sale, purchase, manufacture, delivery, importation, administration, or distribution of any human vaccine used for children under age 6 or pregnant women which contains any organic or inorganic mercury compound in excess of 0.1 microgram per milliliter.

There is an exception made for epidemics. I always hear vaccine advocates saying that thimerosal is no longer an issue, it has been removed from virtually all vaccines. So, again, what is the problem. Why defend the mercury? I know some people say dental types who want to defend the mercury in silver fillings are just trying to prevent lawsuits. Is this the same sort of issue? Mercury was in most vaccines up until very recently, and is still present in some, namely the flu vaccine.

Finally, it allows for a modified schedule for vaccine administration. Again, what is the problem? Why the utter inflexibility? It does not say it allows for any new exemptions. Some diseases do not cause outbreaks generally (bacterial meningitis, hepatitis B), at least not in young children. I can still see how a pediatrician can inform the parents, allay fears, and try to set up a schedule that works for everyone. Is the child not going to be in daycare (which may not accept the adjusted schedule) and not exposed to many people? What’s wrong with waiting on a few?

I think my professor is afraid that making accommodations about vaccines in any way gives credence to vaccine critics. I think the opposite. Making sure vaccines are as toxin free as possible and allowing for some parent autonomy, within reason, actually takes fuel away from the extreme anti vaccine crowd.

OK, have at it. Try to be civil or you may get a square on the bingo card.

18 Comments

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18 responses to “Vaccinations – dipping my toes in the waters

  1. I’ve been thinking a lot about this. My 2 yo hasn’t had any vaccinations yet, and I’m doing some research and thinking about what I’d like to do with her and the new baby. I breastfeed exclusively for 6+ months and for at least 2 years in general, and I also do not put my kids in day care, so we are at very low risk of contracting certain childhood illnesses.

    I am leaning towards doing Dr. Sears’ selective vaccine schedule for this new baby, but making it even more selective (not going to do any vaccines for sexually-transmitted diseases such as Hep B or HPV, for example). Basically that schedule gives 4 infant vaccines (HIB, PC, DTaP, and Rotavirus) on a staggered schedule. Then there’s a DTaP booster at 5 years, I think. You do titers for MMR, chicken pox, and a few others at 10 years old and vaccinate if necessary. And if you’re traveling outside North America or Western Europe, you can choose to do polio at some point.

    I think it’s entirely appropriate to support measures to track vaccine lots, to limit mercury exposure, and to support an alternative schedule. I really like Dr. Sears’ reasoning behind his full-but-rearranged vax schedule for parents who want to do the full series but are concerned about the high levels of aluminum in the combo shots or about giving too many shots all at once, especially more than one live virus at a time. We have nothing to fear from gaining more knowledge. Perhaps it will show some sort of association between vaccines and adverse outcomes. Perhaps not. But either way, we shouldn’t be afraid of opening ourselves to the truth of what these vaccines are doing, good or bad.

  2. This whole vaccine thing has me up in knots. Prior to becoming pregnant I never thought about what vaccines if any I would give my child. It seemed a no brainer. Then, stupid me, I started looking into it all. On one hand, I feel that my life has been better for never having had diptheria or polio or lockjaw. On the other hand I can’t figure out why the state wants me to give my child aluminum toxicity before they can enter public school. One one side you have the people who are against it all because of various conspiracy theories. “They want 2 control r brainez.” On the other side you have the scientific community who keep shouting “Zere is nossing wrong vis the vaccines! No one ever gets sick! You’re crazy!” *they all have German accents in my mind for some reason* Neither side is particularly useful to someone like me who just wants to do whats best for my child. I don’t understand the unwillingness of some in the medical community to look into whether or not the current schedule is too much for tiny bodies. DH and I have decided that until we feel more comfortable about the safety of vaccines we will likely hold off. Our LO wont be going to daycare and there is a good chance that we will homeschool in the future. I think I might have to blog on this one. . .

  3. Until earlier this month my 2 1/2 year old had never had any vaccinations. Earlier this month I decided that I would start vaccinating selectively. I’ve never been entirely against vaccinating. I just don’t understand why our culture feels the need to inject children before their own immune systems have a chance to develop.

    I am all in favor of tracking vaccines. I can’t see why this would be an issue as long as parents have the option to opt out of the tracking process.

  4. Evie

    I think tracking lot numbers would be a good idea, as sometimes whole lots have to be recalled. It would also be informative if children who were vaccinated with a certain lot still contracted the illness, that parents could be contacted and advised that a booster was needed.

    Opting out of tracking is a bit grey for me. When a child is vaccinated, there is a shot record. Attaching a lot number to that record is like having a bar code on a jar of peanut butter. That way, if there’s a problem it can be more easily identified, and measures can be taken. If the child is not vaccinated, then there’s a lack of, or an incomplete shot record, and these kids are going to be tracked through the doctor or school records anyway. I know, I know, HIPPA scmippa, but there’s no telling how long that will last.

    Mercury? Maybe since they’ve proven it safe? for children and pregnant women they’re thinking about putting it back into vaccines, hence the push for legislation.

    I’m also for tracking because it would invariably show a causative relationship between side effects and lot numbers.

    Most importantly, I believe in the right to opt out of vaccines if parents so choose. If vaccines work, then the vaccinated have nothing to fear. If they don’t work, I want to know.

  5. Antarctica

    “Most importantly, I believe in the right to opt out of vaccines if parents so choose. If vaccines work, then the vaccinated have nothing to fear. If they don’t work, I want to know.”

    In general, I’d be happy to agree. But vaccinations aren’t such a black-and-white issue. The magic words in this context are “herd immunity”. The idea is that if the largest part of a population is vaccinated against a particular disease, that disease will not be able to manifest itself, even in unprotected individuals. Herd immunity for most illnesses lies at 85 percent and above.
    But with the current anti-vaccine panic going around, there are some places where the percentage of vaccinated individuals has gone below that critical threshold. I don’t know if you have heard about this, but there have been outbreaks reported of, for example, measles in the UK, Austria, Italy, Switzlerland and the United States. Because of parents who did not vaccinate their children.

    So in the case of vaccines, you can’t simply say that parents should be able to opt out – the people who do so are not only endangering themselves and their children but other people as well. And while yes, those who are vaccinated have “nothing to fear”, there are children who simply *cannot* get those vaccines because of, say, congenital immunologic compromise. And the same goes for children aged one year and younger because they’re normally too young to receive the vaccine. They depend on functioning herd immunity for protection!

    As far as the vaccines themselves are concerned – I am not a doctor, but everything I have read so far very strongly suggests that they are safe. Obviously there is no 100 percent certainty, but it’s pretty much as close to that as it can get.
    The schedule suggested by Dr. Sears in his book “The Vaccine Book” has apparently not been received well, but at least he still recommends that parents vaccinate their children, unlike the “Vaccines cause autism!!!11″ crowd…

    (And I stumbled across this blog at Feministing. Hope I haven’t trodden on anybody’s toes with my comment. :>)

    • MomTFH

      No, Antartica, your comment is welcome. Especially since I put the link up at Feministing! As I said in the original post, I am very torn on this issue right now. I am not policing for agreement with me, since I don’t even agree with myself. I am just looking for good conversation.

      Not every parent who objects to vaccines does it due to the hypothetical autism connection. Many parents have issues with individual vaccines or the schedule, but are not seeking to avoid all vaccines.

      I think herd immunity is important, and that should be one of the many factors in the decision making process for parents. In some small areas of California now, vaccination rates are lower than the 85 or 90% threshold. Parents who think it is relatively safer to skip or delay immunizations due to their children being protected by herd immunity may have to reconsider. (This obviously applies in other countries to varying degrees, depending).

      Also, children with immunological problems may not be able to be exposed to other children who are vaccinated. My immunology professor at medical school told us that his nonaffected child could not take attenuated vaccines because of the risk to his immunocompromised child (this particular type of this particular vaccine could cause a vaccine induced case of polio in the vaccinated child or its contacts, including the immunocompromised sibling). So, again, no 100% black and white here. In this case, skipping a vaccine also protected this child, obviously along with herd immunity of the general surrounding population.

      Also, many vaccines are given to children under one. According to the recommended vaccine schedule, every vaccine except the meningococcal is started before or at 12 months, and all but three start way before 12 months. Yes, there are cases of infants being vulnerable by following the vaccine schedule (in the case of measles, which starts at 12 months, for example) but this does not apply to the vast majority of vaccines.

      What do you think about limiting mercury, tracking lot numbers, and allowing for alternative schedules?

  6. Yes, the mercury-autism possibility is NOT a reason why I hesitate about vaccinating (the mercury itself would give me pause, of course, but thankfully most vaccines don’t have mercury now). It’s other things that I worry about: adverse reactions & other known toxic ingredients in the vaccines and how they may or may not affect my child in particular. I also wish we knew more about how exclusive breastfeeding until at least 6 months and breastfeeding through at least 2 years affected disease susceptibility and severity of the ones we vaccinate for. Given that most infants aren’t exclusively breastfed and very few are still breastfed at all at 12 months, we don’t really know on a large population-wide basis how common or severe some of these illnesses would be for children who are breastfed and not in day care.

  7. Antarctica

    “What do you think about limiting mercury, tracking lot numbers, and allowing for alternative schedules?”

    Well, as far as I know, mercury – or more exact, a chemical compound known as thiomersal or thimerosal which contains about 50 percent mercury – hasn’t been used in vaccines since the late nineties. The only vaccine still containing it is the flu vaccine, which I don’t think too many people get anyway. (And there non-mercury vaccines available now, too.)
    However, even if the vaccines still contained it, there is no scientific evidence for any adverse effects. Mercury in vaccines is often given as a reason for autism, but eight major (and obviously peer-reviewed) studies have proven this assumption to be false. So in either case, mercury in vaccines would not worry me as such.

    About tracking lot numbers, I think I have to ask you to explain that to me in more detail. What exactly is the rationale behind it, and what are the differences to how it is being done now? My apologies – I’m not an American citizen, so I don’t really have an idea of how the system works.

    Finally, the alternative schedules. I guess I see nothing wrong with it in principle (with a big caveat, see below), but there is no indication that spreading vaccination dates out has any positive effect, so why not stick with the recommended schedule?
    If I can talk for a moment specifically about the schedule by Dr. Sears (because his name has come up repeatedly), as I already said in my comment above, his work has not been received well:
    The main reason for his suggestion that vaccines should be spaced out appears to be his concern with the fact that they contain too much aluminium. Or aluminum, if you prefer. :)
    He reports that the amount of aluminium administered through vaccines can be as high as 1,225 micrograms. (He is talking about all the vaccines, basically adding the aluminium together to get a total dose.) That might well be true – the numbers range from about 300 micrograms to 1,300 micrograms, depending on which vaccines are being used – but just throwing it out there, as it were, is both scientifically and intellectually dishonest.
    By 6 months of age, infants have typically ingested 6,700 micrograms of aluminium in breast milk and 37,800 micrograms in infant formula (or 116,600 micrograms in soy-based formula). The aluminium is a negligible amount – and *again*, even if it weren’t, peer-reviewed studies have concluded that the aluminium contained in vaccines does not warrant a change in the schedule.
    So to wrap this up, there is no real reason not to go through with the usual vaccination schedule. On the contrary, spreading the vaccination dates out naturally increases the danger of a child contracting a disease while it is still unprotected. How large of a chance that is, I can’t say (I would guess it is relatively small, depending on where one lives), but in any case my point is not that Dr. Sears’ schedule is particularly bad or harmful* but rather that there are no reported problems or negative effects associated with the “normal” schedule of vaccine administration. It is the best there is at the moment.

    (* Although actually, it might be. Maybe I’ll come back to that in another comment, but for now let’s say that I don’t think Dr. Sears’ suggestion isn’t too much of a problem.)

    I hope I have answered your points satisfactorily. And by the way, I am not making those studies up or anything. They all exist, they are all peer-reviewed, they have all been published in respectable scientific journals, and if you prefer, I will include links to them from now on – I just don’t really want to add a ton of footnotes to my comments, they are already way too long.

    @ Rixa: I’m glad to hear that you are not buying into the autism scare – I wasn’t suggesting that either of you was, but it certainly is in the news a lot at the moment, and as harsh as it sounds, the people trolling around with this claim are… dangerous.

    Regarding breastfeeding, off the top of my head I would say that unless you are HIV positive, there aren’t any dangers associated with it. As far as the vaccines themselves are concerned, I’d say they’re not a problem (see above for my comments on mercury and aluminium) unless your child has, for example, a compromised immune system because of an illness or something. In that case I’d talk to a paediatrician – although I’m sure you do that anyway.
    Oh, and please not that this last part is just me speculating – I’m pretty much certain about everything I’ve written in reply to MomTFH, but my knowledge on breastfeeding is basically non-existent. I’m guessing MomTFH can help you more with that than I.

  8. MomTFH

    Antartica, I would appreciate it if you are going to claim to quote peer reviewed research, please link to it. None of these replies seem to be all that short, so an link when discussing scientific facts like aluminum exposure amounts would be appropriate.

    There are real side effects from vaccines, which you seem to dismiss. There are real harms to real children whose parents follow the regular vaccine schedule. Not that it is their fault. I personally know one family who had a child die from a vaccine reaction, and another who got Guillain Barre syndrome, a serious paralyzing nerve disorder which may have permanent effects. This is a known risk of the meningitis vaccine, and may be a risk of others, like Gardisil.

    Not to mention that some of these vaccines were only researched in a few thousand children. They are required for millions of children, mostly infants, every year. Rotashield was approved, only to be pulled a year later after 76 cases of intussusception, a serious, potentially fatal intestinal blockage, and those were the ones that got reported to the VAERS (Vaccine Adverse Event Reporting System). There were five cases in the clinical trials. Five cases in 10,000 children means potentially hundreds or even thousands a year. 1.5 million kids were vaccinated in the ten months it was administered.

    So, if some parents want to do a schedule in which there isn’t three of these kinds of treatments done at once to their three month old baby, I am fully supportive.

    I think it is strange that you say you don’t know any “dangers associated” with breastfeeding. Breastfeeding should be the norm. Formula is the medical intervention.There are dangers associated with NOT breastfeeding, not the other way around. I think your view of the human body and medicine may be a little more medicalized than mine. I think interventions should be used when indicated, not the default.

    I think what Rixa was referring to was that a breastfeeding mother passes on passive immunity to her infant, so that may indicate that a relaxed vaccination schedule may be appropriate.

    • Antarctica

      Alright, fair enough. :)
      I’ll add the studies from my other comment right after I’m done with this one.

      First of all, if my comments seem cold or heartless, I sincerely apologise for that. I certainly don’t want to dismiss anyone’s suffering, that is not my intention. However, I do think that in such matters it is best to remain as calm and rational as possible.

      Now, I most definitely don’t think that vaccines are the be all and end all of medicine. There are side effects, yes, there is no 100 per cent guarantee that vaccines are safe. I’ll readily concede that.
      But this is, when it comes down to it, a risk assessment. How big is the chance that someone will be affected negatively by a vaccine? And I would posit that that chance is very, very small.

      For example, how big of a risk is Guillain-Barré syndrome? A quick search provides me with a total distribution number of 15 million doses of Menacta (February 25, 2008). Out of that number, there are 26 reports confirmed as GBS within 6 weeks of receiving the vaccine. As there currently does not appear to be precise knowledge of the exact number of GBS in the population, it is unclear whether those 26 cases can be completely attributed to the vaccine. On the other hand, the risk of a meningococcal infection clearly exists. (1)

      As far as Gardasil and GBS goes: There were 31 reported cases of GBS occurring after Gardasil vaccination (mid-2008 number), but only 10 (!) of those have been confirmed to actually be GBS. In five of those cases the person had been given the Menactra shot at the same time. According to the CDC, this number is well within the normally expected range of chance infections after a vaccination.
      And how many doses of Gardasil had been administered up to that point? 20 million. (2)

      I did not know about Rotashield (you make me do a lot of reading at the moment :P), and I can’t really add anything to the Pediatrics article. As the article notes, “even with the benefit of hindsight, it does not appear that the prelicensure experience predicted that a causal association existed.” When a connection was found out to exist, the vaccine was promptly withdrawn.

      Finally, just a little comment regarding the breastfeeding. I’m not suggesting that people don’t breastfeed, quite to the contrary. As you say, breastfeeding should be the norm, definitely. That was just in reply to Rixa saying that she wished more was known on any possible connections between breastfeeding and disease susceptibility. I guess I probably could have put that more clearly. My apologies.
      In that same vein, I’m not suggesting that people just chomp down pills or anything of the sort. Indeed, I think that nowadays that’s done far too much. However, that’s only if it’s about, say, a cough or something. Vaccines are a completely different story because the illnesses they’re supposed to protect us from are very dangerous.

      References:
      (1) http://www.cdc.gov/vaccinesafety/concerns/gbsfactsheet.htm
      (2) http://www.cancer.org/docroot/CRI/content/CRI_2_6x_FAQ_HPV_Vaccines.asp
      http://www.sciencebasedmedicine.org/?p=98

      And if you could tell me how to, well, link those links to words like you did, I’d be grateful. I didn’t want to start experimenting with HTML tags or anything.

      • MomTFH

        Sorry it took so long to approve these, they got shunted to my spam file for some reason. Probably all the links.

        I don’t have time to follow up, unfortunately. As you can see the blog has been quiet, meaning my life is not quiet at the moment. I am leaving for a conference tomorrow, and will be deeply ensconced in board review pretty soon.

  9. Evie

    As per the Sears schedule, if it were incorporated into mainstream, following it would still provide herd immunity in the general population.

    Vaccines are now generally multi-valent, where there are several vaccines whipped up into a single injection. One of the current controversies is that after these multi-valent vaccines were put into use, the autism rate began to climb. It can be difficult to find a provider who will support single dose vaccinations, and they are cost prohibative, so parents who wish to vaccinate on an alternative schedule can find it very difficult to do so.

    Autism is also thought to be most prevalent in male identical twins, and in descending order, male fraternal twins, female identical twins, and female fraternal twins. Twins are commonly diagnosed with chromosomal disorders. The recent lawsuit which was conceded by the US vaccine court identified that mitochondrial disorders can be triggered by vaccinations, but did not define whether the trigger was mercury, other vaccine components, or live/attenuated viruses. Vaccinations, however, are conducted without prior testing for chromosomal or mitochondrial disorders, unless there is an identifiable reason to do so. So should each child have the opportunity to be tested for disorders and allergies before being vaccinated in order to make the decision to opt out? On a strictly voluntary basis after giving valid consent of course.

    And there is the issue of RNA segments of virus and other organic (chicken, monkey, bovine, fetal tissue) components which are still sometimes present in vaccines. Epigenetics research in plants utilizes the insertion of foreign RNA, in conjunction with a virus, to change the way that the plant is growing. I have not heard of a study which utilizes epigenetics to determine if RNA components in vaccines are at play in Autism, however, only a retrospective study would be ethical because to deliberately change human RNA in a growing child for vaccine research is wrong on too many levels.

    Breast fed for 2 years.
    Evie

    • Antarctica

      “As per the Sears schedule, if it were incorporated into mainstream, following it would still provide herd immunity in the general population.”

      Certainly true, but at a later age than is currently the case.

      “One of the current controversies is that after these multi-valent vaccines were put into use, the autism rate began to climb.”
      This controversy seems to be mostly fabricated. Or at least the fact that it is still going on is. The reason that there is an increase in autism diagnoses is mostly due to the fact that the techniques and definitions used to diagnose autism have been refined in the last two decades. Before, many autistic children were diagnosed with, for example, developmental language disorder rather than autism. Today’s standard autism tests, when applied retroactively, falsify the hypothesis of rising autism rates. A connection between vaccines and autism is highly unlikely. (See also the studies I linked to above.)

      • MomTFH

        It is hard to say if there is more autism now or not. Until recently, very little if any surveillance was done on autism. Yes, diagnostics do change, but there was definitely talk in my area of a “pocket” of autism in a certain community. At the time I was taking an epidemiology class, and the teacher, an MD/PhD who worked for the CDC, told me that there was no information available on distribution of autism when I wanted to research it. This was in 2000.

        The etiology of autism, which may be multifactorial, should be examined, not dismissed. New diagnostics for autism may have been a response to the growth of autism spectrum disorders. The fact these new diagnostics exist does not rule out an increase. We have started using BMI to define obesity, but that doesn’t mean it hasn’t increased since before we used it.

        The genetics of autism have not been researched, and there are some strong family associations. What if there are small amounts of gene mutations that make people’s mitochondria vulnerable to thimeresal? Or aluminum? Or something else, possibly unrelated to vaccines?

  10. mrsculpepper

    jumping into the fray

    i have not vaccinted my 3 year old, i’m not planning to update my 9 year olds vaxes. it’s not do a fear of autisim, its partly because of my religious beliefs (blood and animal products) and partly due to a concern for the ingredients including aluminum used as preservatives

    i haven’t done as much research as i probably should have,but it seems like the topic has come up on several blogs i read so i think i’m re-opening my own research

    heres a site that i have started loking at

    http://www.fourteenstudies.org/index.html

  11. mrsculpepper

    oh i thought i’d add, my pets are selectively vaxed…. i don’t play around with rabies

    i vax the furkids because their lives are so much shorter already, and in the case of rabies, it is 100% fatal

  12. Autumn

    I vaxed on schedule and with no reactions beyond a cranky kid and one delayed vax (by 10 days) when the kid came up with an ear fluid ?infection at a well child check. My pedi didn’t recommend antibiotics but did want to vax that day. wanted us to come back in 10 days to be sure the fluid was gone and I agreed to vax then, if the ear was clear. It was and we vaxed.

    Child in question was given to freaky high fevers. I didn’t feel like wondering if it was the ear or the vax in question.

    I want surveillance of all vaccines and a clear picture drawn of what sorts of children do react and how. I don’t understand the lot number issue because in NYS we always document lot and expiration date on all vaxes! I wasn’t aware that we were the exception.

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