We Need Vaccines
tons of germs out there, and unless you keep your baby in a bubble,
she is going to be exposed to a lot of dangerous bacteria. Our
natural immunity can fight off many viruses and certain bacteria,
but there are some very serious illnesses that we just can’t
fight off without help.
evaluate a seriously ill child with a high fever,
we conduct tests: blood, urine, and even spinal fluid exams. That’s
how we get clear statistics on the rates of bacterial illnesses
each year. Luckily, many of these diseases are not very common,
but they are still very real and pose a significant risk to a
young child. One of the benefits of a cleaner society has been
fewer epidemics and fewer deaths attributable to infectious diseases.
But if we relax our guard, and fail to protect our children, we
will definitely see the rise of some horrible infections.
If we look
to our not-so-distant past, we realize just how far we’ve
come in preventing some of the most dreaded infectious diseases.
In the 1940s and ’50s, people lined up around the block
for their polio vaccines. Polio was one of the most dreaded childhood
diseases of the 20th century in the United States. Polio epidemics
crippled thousands of people, most of them young children, each
year. Parents were terrified of polio leaving their children unable
to walk or forcing them to spend the rest of their lives in an
iron lung. Since the polio vaccine became available, the disease
has more or less disappeared from this country, but it still is
rampant in many parts of the world. Travelers come to New York
all the time, so if our immunity as a society waned, there could
definitely be another outbreak here.
is the HIB germ, which was rampant in the 1980s and was the leading
cause of meningitis and pneumonia in children. That germ has virtually
disappeared because of a successful vaccination program. Literally
thousands of deaths have been prevented.
germ (a form of strep) remains one of the most common causes of
meningitis, pneumonia, and even ear infections. Since the creation
of the prevnar pneumococcus vaccine, the rates of children admitted
to the hospital with this germ have gone down significantly. This
germ specifically affects younger children, so once a child is
over 2 years old, the risk goes down. But the risk is highest
among 6- to 24-month-olds, so delaying that vaccine puts a baby
also a very serious disease. It is the leading cause of death
among young children, even though a safe and cost-effective vaccine
is available to prevent it. In 2007, there were 197,000 measles
deaths globally—nearly 540 deaths every day or 22 deaths
every hour. More than 95 percent of measles deaths occur in low-income
countries with a weak health infrastructure. Measles vaccination
efforts have resulted in a 74% drop in measles deaths between
2000 and 2007 worldwide. If we fail to vaccinate against measles,
the disease burden seen abroad will surely return to the United
Concern About Vaccines
There are more vaccines now than ever before. But the body’s
immune system reacts to the antigens in each vaccine, and that
number has actually decreased. Nowadays, vaccines are better targeted
and therefore do not overwhelm a baby’s immune system. Smaller
doses are administered, and “booster shots” are subsequently
given to build the immune system slowly.
have potential side effects, but when you weigh the risks and
benefits, vaccines have significantly improved the well being
of our children. Yet there has been a media frenzy in the past
decade that has led to a real cynicism regarding vaccine safety—specifically,
their relationship to autism.
in 1998, when Dr. Andrew Wakefield, a gastroenterologist from
England published a study postulating a link between the MMR (mumps,
measles, rubella) vaccine and autism. The problem with his study
was that it was very flawed. He used a self-selected group of
patients—those already referred to him with problems, not
a random placebo controlled double blinded study with neutral
unbiased observers—and the number of people he studied was
very small—certainly not enough to prove anything.
when word got out that there was even a possibility of a link
to autism, fear spread like wildfire. Indeed, the number of children
diagnosed with autism continues to go up and no one knows why.
Moreover, an autism diagnosis is typically given around 12 or
13 months of age, and because the MMR vaccine is given at 12 months,
the timing seemed to support the link.
1998, there have been numerous large randomized clinical studies
clearly showing that there is no link between MMR and
autism. Dr. Wakefield himself has retracted his results, and the
journal that published the article has issued an apology for the
flawed study. The results of properly done studies are pretty
straightforward; in a group of 250,000 patients in Denmark where
some did get the MMR vaccine and some did not, it was clear that
in kids who did not receive the MMR vaccine, the rate of autism
was the same.
for the rise of autism is thimerosal, a preservative that was
used for vaccines that can be broken down to a mercury compound.
The toxic effects of mercury have been known for a long time.
The Mad Hatter in Alice in Wonderland, like many hatters of the
old days, handled mercury in his trade and suffered the consequences.
But there is a big difference between methyl mercury, which is
toxic and can get into the central nervous system, and ethyl mercury
(the thimerosal compound), which is less potent and can’t
get into the nervous system.
after a fear over mercury developed, the American Academy of Pediatrics
demanded that all vaccines be made without this preservative.
Since 2001, all vaccines (with the exception of some adult flu
vaccines) are not preserved with any mercury component. Nonetheless,
autism cases have continued to increase in the past eight years,
so the culprit is clearly not thimerosal.
of and potential cures for autism remain a mystery, but scientists,
politicians, activists, and pediatricians are 100% behind the
efforts to solve it. The only thing that seems clear at the moment
is that vaccines are not at the root of the problem.
Is Autism on the Rise?
Part of the
reason why there has been an alarming increase in the incidence
of autism is because we are now able to screen for and identify
signs of autism much earlier than before—even before a child
reaches his first birthday. Not long ago, children with autism
were often misdiagnosed; they were labeled as mentally retarded
or speech delayed, or just missed altogether. Nowadays, everyone
from parents to teachers to doctors is vigilant in the search
for autism, and this contributes to an increase in cases officially
There is a
genetic basis to autism, and researchers are currently looking
for a gene that predisposes a child to the condition. There may
also be something in the environment that causes autism. It may
be something that mothers were exposed to while pregnant, as the
most common forms of autism are apparent in newborns. The case
of a child developing normally and talking well, only to spontaneously
regress, is actually quite rare, and not your typical autistic
child. The usual presentation of autism includes the inability
to form interactions, connections, or communication skills, not
a loss of skills that were already acquired.
or Altering the Vaccination Schedule
people worry that there are too many vaccines, and that the immune
system will be overwhelmed. The problem has been thoroughly studied
by scientists and that is how the current vaccination schedule
has been created. Before a vaccine is added to the schedule, there
are many studies conducted to measure the success of the immunity
based on blood tests and any side effects. The most common side
effects are fever and muscle aches or soreness. But the vast majority
of babies and children have absolutely no reaction to any vaccines.
We have already
determined that giving a vaccine to a child before they are 6
weeks old is not as effective. But after 6 to 8 weeks, a child’s
immune system can and does accept and incorporate the passive
immunity afforded by the vaccines. The vaccination schedule allows
a child to develop enough immunity to have the best chance to
fight off the germ by the time the child is most likely to encounter
that germ. If parents feel more comfortable splitting the first
few rounds of vaccines—in other words, instead of getting
all the shots in months 2, 4, and 6, getting some in months 3,
5, and 7—the delay of one month is not a big risk to the
child. I personally think the child would rather get it over with
in three days of pain rather than six, but I try to make the parents
Dr. Bob Sears
is a pediatrician who has written a book promoting an alternative,
delayed schedule. He raises many good theoretical questions—like
can aluminum preservatives in vaccinations cause harm—but
he offers few answers, and he may only be adding fuel to the fire.
There is a recent
article in the Pediatrics journal about some babies
getting illnesses that were preventable because they were on a
Who Can We Trust?
I was raised
by a midwife mom who created a doula company more than 20 years
ago, and a dad who was one of the original consumer reporters—always
looking out for scams and companies not telling the whole truth.
In medical school, I was a bit skeptical of Western medicine at
first, and I challenged a lot of what is taught. Pharmaceutical
companies provide huge financial incentives for doctors, and I
have observed firsthand the shortcomings of the FDA.
But now I
balance that skepticism with what I’ve seen in my 15 years
of caring for children. Children with pneumonia or blood infections
can suffer greatly, and meningitis can even take their lives.
Such extreme cases require treatment with antibiotics.
I take a balanced
approach to medicine, and I am sure that the benefits of antibiotics
and vaccinations outweigh any theoretical risks. I had to reexamine
all of my beliefs when I went through the vaccination schedule
with my own daughter, but she received them all and did just fine.
The best plan
is to find a good pediatrician who you can trust—someone
who is very well trained, intelligent, and able to analyze the
information that’s out there. They must also possess the
ability to work well with any type of family. I believe that informed
parents should be able to make the final decision when it comes
to their children. I don’t turn away any family, even those
that refuse all vaccines. But the thing that parents need to remember
is that even with the Internet, medicine is a doctor’s area
of specialty. I stand over the plumber when he fixes the sink,
and I nod my head a lot when the mechanic fixes the car. I research
the stock market and certain laws. But in the end, I trust in
the experts of these fields. With our children’s health
at stake, we have to be comfortable following the advice of their
doctors. I hope that I can be that person when it comes to infectious
diseases, vaccines and the array of perplexing pediatric issues.
We use a combination
vaccine called Pentacel that is safe, effective and without any
increase in side effects. It combines Dtap, Polio, and HIB into
one needle. When there is a Pentacel shortage, we use Pediarix
instead. The other vaccines for the 2-, 4-, and 6-month visits
are the oral rotavirus vaccine, the prevnar (PCV or pneumococcus)
vaccine and the Hepatitis B vaccine. That is a total of three
needles and one oral vaccine. For those parents who feel strongly
that we should give only two needles, we can delay the Hepatitis
B vaccine until later, as long as both parents are definitely
Hep B negative on blood tests and are willing to take the very
small but real risk that there could be Hep B contact through
events such as blood transfusions or human bites.
parents insisting on splitting the vaccines into two separate
schedules, we could give the Pentacel and rotavirus ones on months
2, 4, and 6, and the Prevnar and Hep B on months 3, 5, and 7.
I feel strongly that any further delay in the vaccines is not
safe, but if both parents insist on delaying the vaccines in a
different way or forgoing some vaccines altogether, I will do
my best to guide and support you. In those cases, I will need
you to sign a statement saying that you are aware of the risks
of not vaccinating your child. I will also need you to give me
in writing your proposed schedule.
first three rounds of the Pentacel, PCV, Hep B and Rota, we would
take a break until 12 months old. At 12 months, we would give
the MMR, Varicella, and Hepatitis A vaccines. At 15 months, we
would give the fourth (and last) HIB and Prevnar vaccines. Then
at 18 months, we would give the final Dtap and second Hepatitis
At 4 years
old there are four booster vaccines: Dtap, Polio, MMR and Varicella.
At 11 years we would give the Dtap booster, as well as the meningitis
get the gardasil/HPV vaccines at any age after 9. There are three
shots in total.
We also recommend
the flu shot for all children every year, but especially for those
with asthma or who are younger than
6 years old. The first time children get a flu shot, they will
need a booster one month later if they are less than 9 years old.
If they are younger than 3 years old, the dose is smaller (.25ml
instead of .5ml).
All of our
vaccines, except certain adult flu shots, are thimerasol free.
is a summary on vaccines issued by the American Academy of Pediatrics,
and a short list of other helpful websites.
From the American Academy of Pediatrics
The AAP understands that parents may have concerns about vaccinating
their children. Vaccines are one of the most successful medical
advances of all time. Vaccine safety is an issue of great importance
to the AAP and to pediatricians, who support ongoing research
and increased funding in this area. In addition, the AAP supports
further research into the causes of autism. The following information
is to help parents and caregivers to understand some of the common
issues and questions surrounding this topic.
What Is Autism?
Autism is not a specific disease, but rather a collection of disorders
of brain development called “autism spectrum disorders,”
or ASDs. Studies show that the prevalence of autism has risen.
The apparent increase in autism may be due to a combination of
factors. For example, more and more behaviors and disorders are
being included in the definition of ASD than in the past. Also,
the public and the medical profession recognize these disorders
According to the Centers for Disease Control and Prevention (CDC),
about 1 in 150 children have an ASD. Although many theories have
been discussed, the cause or causes of autism are not known. Autism
has a strong genetic basis. Currently about 10 percent of cases
are connected with genetic conditions such as Fragile X or Prader-Willi
syndromes. According to a January 2008 study, researchers have
discovered another genetic mutation that could account for higher
risk in another 1 percent of autism cases.
More research is being done every year to try to identify the
causes and improve efforts to prevent, diagnose and treat ASDs.
The nation’s top experts in pediatric neurology, genetics,
and other fields are moving closer to answers about this group
Early diagnosis is crucial. Pediatricians should screen all children
for ASDs at 18 and 24 months. They should also listen carefully
to parents about their child’s development. The AAP provides
its members with comprehensive tools and education to assist them
with both diagnosis and follow-up. Parents are the most reliable
sources of information. When a child is diagnosed with an ASD,
the child’s family and caregivers should be given information
and support. The child should be involved in autism intervention
programs as early as possible to get the most benefit.
What Is Mitochondrial Disease?
A recent case that was awarded compensation through the federal
Vaccine Injury Compensation Program involved a child with a mitochondrial
disorder or mitochondrial disease. This case has raised questions
about what environmental triggers might bring on or worsen autism-like
symptoms in children with such disorders.
Mitochondria produce the energy needed for cells to function normally.
There are a number of genetic disorders that cause mitochondria
to produce less energy than cells need. Symptoms of these disorders
can be very mild or quite severe. In some of the disorders, symptoms
do not develop for many years. Some of the rarer mitochondrial
disorders affect the brain and cause worsening neurologic symptoms
over time. In many cases, an event that requires more energy,
such as an infection, fever or other illness, can lead to the
development of symptoms.
Although details of the case and the decision cannot be disclosed
by the U.S. Department of Health and Human Services, the agency
published a statement on March 3, 2008, which said: “HRSA
(the Health Resources and Services Administration) has reviewed
the scientific information concerning the allegation that vaccines
cause autism and has found no credible evidence to support the
According to the Centers for Disease Control and Prevention (CDC),
this was a unique case and information about it has not been accurately
characterized in the media and other public forums. It represents
one special case and does not change the immunization recommendations
for children in whom vaccines are otherwise recommended. More
information is available at the CDC Web site: www.cdc.gov.
According to the United Mitochondrial Disease Foundation, “There
are no scientific studies documenting that childhood vaccinations
cause mitochondrial diseases or worsen mitochondrial disease symptoms.
In the absence of scientific evidence, the UMDF cannot confirm
any association between mitochondrial diseases and vaccines.”
What About Vaccine Safety?
Every physician is mandated to report adverse effects of vaccines
to the Vaccine Adverse Event Reporting System (VAERS) so that
the event may be studied further. Any adverse effects are acted
upon immediately when there appears to be an association. For
example, a Rotavirus vaccine that was found to be associated with
an intestinal condition called intussusception was taken off of
From time to time, rumors circulate that thimerosal, a mercury-based
preservative once used in several vaccines (and still used in
some flu vaccine), could contribute to ASDs. However, valid scientific
studies have shown there is no link. The American Academy of Pediatrics
(AAP), the American Medical Association (AMA), the CDC, and the
Institute of Medicine (IOM) agree that science does not support
a link between thimerosal in vaccines and autism.
Some parents are concerned about “combination” vaccines,
which protect against more than one disease with a single shot.
For example, the MMR vaccine protects against measles, mumps and
rubella. These vaccines have been studied carefully and found
to be safe. All vaccines contain antigens, which cause the immune
system to do its work to fight (and protect the body from) infections.
It is important to remember that children are exposed to many
antigens during normal activities, such as playing outside or
eating food, or when sick with an infection. Healthy children’s
immune systems are equipped to handle these multiple exposures.
Why Are Vaccines Important?
It is most important that parents and pediatricians continue to
rely on immunizations to protect all children from preventable—and
potentially deadly—illnesses. Many vaccine-preventable diseases
can have dangerous consequences, including seizures, brain damage,
blindness, and even death. These diseases still exist even though
many young parents today have never seen a case, due to the success
of the nation’s current immunization program. Death and
harm from chickenpox, measles, meningitis and other diseases are
still a threat to children who are not protected.
Some specifics: Before HIB vaccine became available, there were
approximately 20,000 cases annually. HIB was the most common cause
of bacterial meningitis in children in the U.S. HIB meningitis
once killed 600 children each year in this country, and those
who survived often had deafness, seizures and/or mental retardation.
Measles is another example of a vaccine-preventable disease with
serious consequences. Currently in the U.S., up to 20 percent
of people with measles are hospitalized. This is one of the most
infectious diseases in the world; if vaccinations were stopped,
each year about 2.7 million deaths from measles worldwide could
be expected. A recent outbreak of measles in San Diego, California,
11 children contracted measles and none had been vaccinated. This
is the highest number of measles cases San Diego has seen in 17
years. It is believed to have started with a child who caught
measles in Switzerland and then returned to the U.S. Likewise,
it would only take one case of polio from another country to bring
the disease back to the U.S. if people are not protected by vaccination.
In order for vaccines to protect everyone, an estimated 85 to
95 percent of the population must be immunized. Studies have shown
that children who are not immunized are more likely to become
infected with measles and pertussis. Younger children often are
the most vulnerable; 90 percent of deaths from pertussis are in
infants younger than 6 months old.
It is not advisable to skip or delay vaccines, as this will leave
the child vulnerable to disease for a longer period of time. Parents
should follow the immunization schedule provided by the CDC and
its Advisory Committee on Immunization Practices, the AAP, and
the American Academy of Family Physicians (AAFP) each year. This
schedule is designed by experts to ensure maximum protection and
safety for children at various ages. Parents should discuss any
concerns with their child’s pediatrician. Serious events
occur more often from the actual infection or disease, rather
than from the vaccine; therefore, the vaccine is much safer.
For more information on vaccinations, here are some helpful
For a look
at my recommended vaccination schdule, please click here.
Please note that when there is a Pentacel shortage, we use Pediarix
instead; click here to see that schedule.
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