To Vaccinate or Not?
Parents Worry About Safety
By Anita Manning in USA Today.
"If youre going to choose not to vaccinate your child because
of fear, you have to think what you will do if your child ends up with
this. I was obviously one of those people who thought this wouldnt happen
to me. Or to my daughter."
Anne Marie Worthy of Richmond, Va., believes in the value of vaccines. She learned the hard way.
In 1990, her daughter Amanda was 3. A vaccine had just been licensed to prevent infection with Haemophilus influenzae Type B, or Hib, which caused about 15,000 cases of bacterial meningitis and up to 500 deaths each year. Because it was new, "I thought it sounded a bit scary," she says. When her pediatrician offered to immunize Amanda against Hib, "I said, Im not going to do that." The illness started with what looked like a cold, with coughing and fever. The pediatrician examined the little girl but saw no reason for alarm, so Worthy dropped Amanda at her mothers house and went to work.
That afternoon, "Amanda woke from a nap looking pale. My mother knew something was wrong," Worthy says. "She was turning pale because her throat was closing." Amanda had epiglottis, a severe swelling of tissue in the throat that is caused by Hib bacteria. It is a medical emergency, requiring immediate opening via tube or incision.
When Worthys mother called the doctor, he told her to get the child to the emergency room. Doctors thought her chances of survival were slim. She wound up spending three weeks in intensive care. But she pulled through.
Today, at 13, she is deaf in one ear and has a learning disability that requires daily Ritalin medication to stimulate brain cells.
"All from not getting her a vaccine," Worthy says.
The lesson, she says, is "if youre going to choose not to vaccinate your child because of fear, you have to think what you will do if your child ends up with this. I was obviously one of those people who thought this wouldnt happen to me. Or to my daughter."
Doctors are growing increasingly worried that high vaccination rates in the USA may be jeopardized by rising public concern that vaccines may pose more risks to babies than the diseases they prevent.
Some researchers have published reports that suggest a link between vaccines and autism, diabetes, or other chronic or developmental disorders.
Other researchers have disputed the findings, but the controversy has become the focus of several congressional hearings and countless Internet chat-room discussions.
Vaccine safety is the focus of a panel discussion Wednesday at the International Conference on Emerging and Infectious Diseases in Atlanta.
Adding to parental fears are last years withdrawal of the new rota-virus vaccine because of an association with an intestinal blockage called intussusception, and publicity surrounding the use of thimerosal, a vaccine preservative that contains mercury.
"Weve not yet seen an impact in our national data, as they have seen in the United Kingdom, where theyve been able to document that measles coverage is dropping," says Walter Orenstein, director of the National Immunization Program at the Centers for Disease Control and Prevention.
States require vaccinations for children in public schools unless there are medical reasons a child should not be immunized, such as a severe allergy to something in the vaccine or a compromised immune system. All states except Mississippi and West Virginia grant exemptions based on religious beliefs, and 17 states consider philosophical objections.
Areas of vulnerability US surveys find that, overall, only 1% to 2% of parents refuse to vaccinate their kids by the start of school, Orenstein says, but the data may not reflect recent trends or pockets of vulnerability. "Our concern is there may be communities where (unvaccinated) children may be clustering, where they have a risk of vaccine-preventable disease," he says.
"Whats happening in this country over the last 10 years is that weve changed our definition of safety," says Paul Offit, chief of infectious diseases at Childrens Hospital of Philadelphia. "It used to mean protecting from harm. Now what we mean by safe is something has to be absolutely free of negative consequences." Thats unrealistic, he says. "Nothing is absolutely safe."
People die from choking on food or taking baths. Amoxycillin (a common antibiotic) kills children every year. So does chocolate. So do peanuts." Thats one reason why studies are needed to determine which children are most vulnerable to a bad reaction to vaccines, says Barbara Loe Fisher of the National Vaccine Information Center in Vienna, Va., an advocacy group for those who question vaccine safety.
"We dont know what these vaccines, biologically, are doing to some children," she says. "Today, a 12-month-old child can get 10 vaccines on one day. If they have a problem, its very difficult to know which vaccine caused it. With so many unknowns . . . it is really a shot in the dark." Health officials may be overstating the dangers of failing to vaccinate, Fisher says.
"There were only 100 measles cases in 1999," she says. "When I was growing up, I remember when one kid on the block would get it, the mothers would hope all the children got it, to get it over with. When you think back then, with the exception of polio, there wasnt this fear, anxiety and hysteria about getting measles or chickenpox. It was a rite of passage." But Offit, co-author of Vaccines: What Every Parent Should Know, says measles is no joke. He well remembers the last major outbreak, in 1989 to 1991, when more than 55,000 cases were reported nationally, and there were 123 deaths.
In Philadelphia, Offit says, 1,600 children caught measles, and nine died. The disease begins with a cough and a runny nose, then a rash appears on the face and spreads to the trunk. Many children develop severe pneumonia, and some suffer encephalitis that leads to brain damage. There is no effective anti-viral medication to treat it. "At the heart of the outbreak in the city was a Baptist church whose members chose not to vaccinate" their children, Offit says. Seven of the nine children who died were from that church. The others were babies who lived nearby and had not gotten their measles vaccines.
Offit remembers those children, he says, when he hears debate over whether vaccines should be mandated. "Should that freedom (to refuse vaccination) extend to having the right to contract and ultimately pass on a serious and occasionally fatal infection?" he asks.
The public health impetus for widespread immunization is "herd immunity," says the CDCs Orenstein. If most people are vaccinated, there are too few susceptible people in a community to allow bacteria to circulate.
"When parents refuse to have children vaccinated, their kids get protected if the people around them get their kids vaccinated," he says. With measles, "we clearly do not have 100% immunization, but we have no measles because our (herd) immunity is high enough." But between 1997 and 1999, there were 116 cases of measles carried into 33 states by people from other countries, Orenstein says.
"If enough parents stop vaccinating against measles, then were going to have a problem." Peggy OMara, publisher of Mothering Magazine, which promotes "natural family living," says many readers question vaccines "from a philosophical point of view. . . . People say its the condition of the host thats important. If a person is healthy, theyre going to fight off disease.
They think, for instance, with measles that true immunity is achieved through the disease, and the vaccine wears off." The idea of allowing parents to opt out of vaccines "terrifies" public health officials, who foresee "a community devastated by disease," she says.
"The points of view of the public health person and the parent are irreconcilable." Parents care primarily about the health of their own children, OMara says, and they dont want to be "coerced into making a decision" that they, and not a public health official, will have to live with. She adds: "I think we can tolerate a small number of people who conscientiously object to vaccines. Most people do what their doctors tell them to do."
Decision not to vaccinate Some choose not to. Heidi Goldstein of Tenafly, New Jersey, has decided not to have her daughters, Isabel, who will be 5 in August, and Olivia, 21 months, vaccinated.
"Its a big commitment, a big step," she says. "Ive worked as hard as I can to educate myself. Im not dismissive of what the medical community has to say, but my husband and I have to do what we believe in and nurture our children naturally." Goldstein is trying to make sure her girls are as healthy as possible by providing organic foods and using medications sparingly. She tries to build strong emotional bonds by sharing her bed with the girls and breast-feeding them longer than usual -- shes still nursing Olivia.
"My goal is to keep my kids as strong and pure as possible," says Goldstein, who consults with both a pediatrician and an herbalist. "They come into this world with a physical integrity that shouldnt be tampered with. Im not against medicine. Im just trying to strengthen and bolster the immune system naturally." She believes this is the right choice for her daughters. "Im sure most parents would think Im really crazy for questioning what the government or school officials would ask of me," she says. "Im just doing what feels right. And I know theres a risk to everything." Healthy kids are better equipped to fight off infection, Offit agrees. "Its true that if youre very healthy, youre less likely to be overwhelmed by a virus or bacteria than if youre unhealthy," he says. But "call me old-fashioned. I still believe in the germ theory."
Improved hygiene and sanitation in the early 20th century "provided some relief against death from these diseases," he says, "but we never seriously started to get rid of them until vaccination." A vaccine to prevent diseases caused by pneumococcal bacteria has been approved and is being recommended for routine use in a series of four shots between 2 months and 18 months of age.
"Ive heard many physicians say with the new vaccine, given what happened with the rotavirus vaccine, they want to wait" to make sure no unforeseen side effects emerge, Offit says. That may appear to be a cautious approach, he says, but it "assumes that the physician is willing to take the risk that the child will not get one of the most common causes of meningitis, bacterial pneumonia, sepsis (blood poisoning). Thousands of children die every year of that bacteria."
By holding off on vaccination, he says, "you substitute a theoretical risk from the vaccine for a real risk. Were willing to accept a negative consequence given to us by God, but not one given to us by man.
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