Last Friday I was in line for a coffee and met a newborn baby. Her father asked me if “I believed in vaccines.” I answered him (hint: I do). But then I got to thinking…how could I have done it better? I wrote some friends…
Two Minutes To Represent Vaccines?
Last Friday I was in line for a coffee and met a newborn baby. Her father asked me if “I believed in vaccines.” I answered him (hint: I do). But then I got to thinking…how could I have done it better? I wrote some friends…
The more I think about this the more I think that this could become something of a meme. Why not get every pediatrician in America to create a 2 minute video addressing this very issue? The issue of vaccine safety/hesitancy needs dialog and this might be the spark that it needs. (eyes darting, having flight of ideas…)
Jay Gordon says
My experience is different than yours. I last treated bacterial meningitis in a child in 1983. I hospitalized a child for pertussis in 1984 (very ill) and once in 1994 (young infant who was in and out in 2-3 days) and none since. I have a very large number of unvaccinated families in my practice, 99% breastfed, 80% BF>one year and probably 25-30%>18 months. I trained in the late 170s in a large excellent pediatric center and know that these illnesses are not eradicated. I know that children contract vaccine-preventable illnesses and I also know that I have the luxury of being accepting and even encouraging of delayed or selective vaccinations because of vaccines and herd immunity.
Nonetheless, I see many children for second or third opinion consultations regarding autism and other conditions which parents believe resulted from vaccine injury. I have no proof. They have no proof. But a large collection of anecdotal evidence is worth considering. “Evidence-based medicine” is important but not the only answer to a lot of questions. I have seen a lot of evidence that vaccines can cause harm as well as doing good. I know that I suffer from confirmation bias and a strong dislike for the current vaccine schedule, which I think has very little scientific support: Even if one feels strongly about vaccination there is still not enough proof that the way we vaccinate is as safe as it could.
I think that your “two minute” idea is clever but, unfortunately, that’s really all the discussion parents actually get in most pediatrics practices. Until we acknowledge the possible risks and benefits to each individual child and accept parents’ right to participate in the discussion, we’ll convince more and more parents that we’re not listening.
Congratulations on having a fine website, Seattle Mama Doc and for opening a vaccine dialogue.
Jay Gordon, MD, FAAP
Perhaps I need to watch Wendy’s video again but I’m guessing that her 2 minute project isn’t another free platform for anti-vaccine propaganda. We’ve seen enough of that and God know our young parents have seen enough of it.
It’s time for a new message. It’s time to reverse the veiled suspicion instilled in young parents by messaging like yours. These parents deserve the collective voice of America’s pediatricians – not more ‘debate.’
I might suggest that you take your “we can’t prove they do/we can’t prove they don’t” argument over to Age of Autism where its plummeting readership continues to bask in the glory days of thimerosal.
In the event that the vaccine-autism connection is unclear, you might reference the Everest-sized stack of evidence refuting the link. While I’d like to declare that it’s finally over, it seems the vaccine-autism connection was dead before it ever began.
A great book I would recommend is Autism’s False Prophets by Paul Offit. He offers a compelling overview of the fraud and manipulation that initiated the thinking so pervasive among anti-vaccine propagandists. If you don’t have a copy, I’ll lend you mine.
Jay, applause to you for that post! I have a similar practice and a similar experience, except I have never seen a serious case of pertussis in my 15 years. (I know, next week I will now that I put that in writing.)
In my practice, my flexibility about vaccine schedules and willingness to have an honest reasoned discussion that is ongoing over several visits actually increases my families’ willingness to ultimately vaccinate, and seems to me to be more successful in the long run than just saying, “Vaccines are safe and you should give them.”
It is a tricky issue, and I don’t believe it is as straightforward as the AAP and ACIP might have us all believe.
Also, Seattle Mama Doc rocks, on the web and in person!
Deb Z, MD FAAP
Wendy Sue Swanson, MD says
Thanks for your comments, all, I await your experienced answers after you read the posts that reflect the pediatricians’ thoughts who answered the e-mail.
Before I respond to all of the thoughts Jay presented, I don’t want to get ahead of myself. This video only explains how this conversation began. This is not a gimmick or ploy to find a way or method to discuss vaccines. Rather, this really happened last Friday while I was in line at Met Market getting coffee. I really fret about it until I wrote the e-mail to my friends and peers.
I really want to listen to families. I want to understand what their concerns are. I want to understand as much about vaccine as I can, to better advise parents. I want to give really good advice. I think most of my colleagues (and you all) feel the same way.
Organically, this coffee line situation happens over and over again. Tonight while running errands with my mother, a woman recognized me as a pediatrician and… drumroll, asked “what I thought about vaccines.” Blew me over. I didn’t say a word about medicine– she recognized me, had me for a minute, and asked the one weighty question. I was almost speechless (okay, not really, it’s not in my nature but I did feel more than usual ineffectiveness) because I’m so wrapped up in this process right now. It’s everywhere (confusion and simple wondering about vaccines)—families ultimately feel they are left worried and confused.
I think you’re right that families often get no more than 2 minutes to discuss vaccines in a 15-20 minute comprehensive check up.
But this post and the future posts (like DrV assumed) are certainly not another project to exert the paternalistic, thin, “vaccines are safe and you should get/give them” rhetoric. It just isn’t where these pediatricians sit. That’s what makes this interesting, and ultimately helpful, I hope.
This is a post and a series of conversations to dialogue and expand how families acquire information from pediatricians and how they can learn why the FAR majority of pediatricians recommend vaccines on the AAP schedule.
I really am thankful for all of your comments. It is good to know where we all reside so that all of us, who raise children, can make better, informed decisions.
Dr V, don’t spoil our fun. I was just about to make some popcorn. Mama Doc invited 33 pediatricians to comment. Collectively, they speak passionately and emotionally in favor of vaccines. It appears 2 more pediatricians joined the party who have different experiences. Let them speak.
Mama Doc, I have more questions:
** Why do some Drs still advise against the MMR? (My kids do have immune-related bowel disease, so Dr Wakefields initial aligations got my attention. Studies that refuted him were a huge relief to us.)
** What’s the difference between ethyl mercury and methyl mercury? Is there conclusive evidence ethyl mercury is completely non-toxic? (My child with chronic bronchiolitis got his flu shot anyway because he’s had combo viral / bacterial double pneumonia and it wasn’t pretty.)
** Does ethyl mercury cause or exasserbate bowel disease?
** Did low-vaccination rates lead to epidemics in Scottland, Japan, and now California?
** Why don’t more Drs work with their patients to devise alternative schedules than the aggressive CDC schedule? (IMO, this seems more like a medical management question than a scientific one. Many Drs in our ped’s group refuse to comment on an alternate schedule. If you go counter to CDC, you are on your own to come up with a plan. The MA will give you basic info on timing if you choose to catch up. Our ped finally broke from the fold and advised on what she felt was most urgent and what could wait until the next shot appointment.)
** How do Drs respond to other Drs like Dr Jim Sears and others who claim that some diseases, like Hep A, aren’t serious in young children. Or that Hep B is given at birth because parents are less likely to give it later when child is a young teen and is more at risk? (PS: I did buy Dr Jim’s book. The vax info wasn’t useful and he was clearly not informed. I do know that he bridges the gap for families whose Drs won’t speak counter to CDC and AAP.)
Thanks! I’m looking forward to your write-up from your colleagues.
Wendy Sue Swanson, MD says
I’m going to take these a few at a time. And there are a few questions I can’t answer without some help.
1) I don’t know why they wouldn’t advise MMR. Who are these docs, and why?
2) Let’s start with Thimerisol (mercury containing preservative that was previously in immunizations). It’s no longer in any shots in the US for kids except multi-dose flu shots for children over age 3. Nasal Flumist does not have Thimerisol. Ethyl mercury is the mercury found in preservatives used to protect vaccines from contamination.
Watch this video for an explanation re: methyl versus ethyl mercury. Although she speaks a bit slowly, the content is great and goes over the basics:
3) I’ve never heard that ethyl mercury causes or flares bowel inflammation or disease. Anyone else want to comment?
more later, Viki.
thanks for the comments/questions.
Actually I’m having fun, Vicky. Watching actual practicing pediatricians alter vaccine schedules on the advice of former pornstars is better than reality TV.
Send the popcorn over when it’s ready.
As a parent, I’d be pretty worried about a pediatrician who thought he or she had a better understanding of the proper timing of vaccinations than the entire American Academy of Pediatrics Committee on Infectious Diseases *and* CDC Advisory Committee on Immunization Practices put together.
Free thought, independent medical judgment, yeah – but with my kid, please don’t be playing around in specialties you don’t understand. The schedule is the way it is for a reason.
I’m really impressed with your open, informed and honest information Dr. S. Thanks for starting this!
My doc does not turn away patients who don’t want to vaccinate. And I am someone strongly in support of vaccines. However, he is kind, open, informative, and gives them all the information he can as to why they should and why it would be better to be on schedule. He doesn’t, however, push them. I think that makes a huge difference (as a previous commenter mentioned) in more of his patients ultimately opting to do it. And even if they don’t, at least someone is caring for their child medically and can recognize issues if/when they come up. Because a Dr. yelling at a parent is not going to make them suddenly change their stance. They’ll just go more underground with it.
Even though I’d rather all the kids in my doc’s practice be vaccinated, I have to take the good with the bad for me. I chose him because he is also open to all of MY concerns and open to whatever parenting style each parent chooses, as long as it’s not abusive. My previous doctor berated me every time I went in because my 2 month old was jumpy at weird sounds in the Dr’s office and blamed his collicky behavior on me “holding him too much” and “not letting him cry it out.” (as an infant. Good Lord)
I have a 5 month old. I currently live in Peru. She has not had any vaccinations. I plan to do some after she is 6 months. I don’t want an agressive schedule. The Dr. Tenpenny information is very convincing. Could someone comment on her information and why one shouldn’t agree with it. I really feel confused about this decision.
isles, actually I agree! The dose spacing for childhood vaccines is well known so that physicians can get individual children caught up. It does require time to document. As more practices move to electronic recods management (incl shots), I think this will get easier. Even CDC now has a little app you can download that tells you how to “catch up”.
Laura, I’ve read one article in Huff post where Dr Tenpenny stated that vets are more humane than pediatricians because they work with pet owners to tailor vaccinations to the individual animal. (OUCH!) I am definitely interested in why there is so much discord about “timeliness” when it’s clear different timeframes can work. However, I stop listening when someone like Dr Tenpenny dismisses the disease. Just because a disease isn’t usually fatal doesn’t mean it’s an experience I wanted for my child.
I am a parent, and a pediatrician who specializes in infectious diseases. I vaccinate my daughters along the AAP recommended schedule.
@Seattle Mama Doc- Thanks for talking about this vital topic. I agree with you that vaccines are critically important for children’s health, and I look forward to hearing from various pediatricians their strategies for allaying largely unfounded fears about vaccination.
@Viki – Do low rates of vaccination cause epidemics? Certainly. for example, there have been increasing numbers of measles cases in this country, especially (but not only) in unvaccinated people. Look for an articles in 2010 in Pediatrics by Sugerman, and in the New England Journal of Medicine in 2006 by Parker.
@Jay, DrZ – you’re fortunate not to have seen many terrible outcomes with vaccine-preventable diseases. I work in the tertiary care setting and recall cases of children I have seen die from pertussis, pneumococcus, late complications of measles, seasonal influenza, H1N1 influenza, and meningococcus. I have seen tetanus, and cervical cancer caused by HPV, and severe rotavirus, and varicella that caused paralysis.
These diseases exist. We hold them at bay through our use of vaccines, and those of us in the US are lucky to live in a country with high vaccination rates, protecting us through herd immunity. And that herd immunity is critical for children too young to be vaccinated, or people (say, on chemotherapy) who cannot be vaccinated for other reasons.
The AAP vaccination schedule is designed to maximize that protection for our children. If wanting to do everything possible to protect children is your mission, then, yeah, I guess you could call that “aggressive.” It’s a subject I think we should be aggressive about.
Offering no vaccination or delayed vaccinations provides children all of the increased risk of these terrible (and preventable) diseases without any benefit. Their neurodevelopmental outcomes are no different than children vaccinated using the routine schedule. Every month you delay vaccination is a month a child could suffer needlessly from a preventable disease.
You wouldn’t tell a parent, “Hey, I understand that you think your child is uncomfortable in her car seat, so why don’t you leave her out of it until our next visit. Let’s delay using the car seat until then.”
Just as we never know when a serious car accident will happen, we cannot predict when a serious infection will happen. And they do happen. So we should do everything in our power to be in those car seats and to be vaccinated so we are ready when those terrible events happen.
@Seattlemamadoc, thank you for introducing this topic! Interesting to see what voices come out of the woodwork on this one.
I am a pediatrician who specializes in gastroenterology and within gastroenterology, specializes in the treatment of children who have liver disease. Before pursuing my subspecialty training, I also worked as a general pediatrician. I have trained in the last decade, and therefore, have witnessed the tragedy of infants dying on ECMO (Heart lung bypass) from contracting pertussis, as many of my contemporaries who work in hospitals also have.
@ viki: Delayed vaccination of hepatitis B has been definitively shown to lead to increased rates of chronic hepatitis B in children. As a hepatologist, I am incredibly concerned by the lax attitude towards vaccination for hepatitis B. Hepatitis B, in its chronic form, has treatment but no cure. 350 million individuals worldwide have chronic hepatitis B, which will ultimately, after decades of infection, lead to cirrhosis, liver failure, liver cancer, and death. There are substantial numbers of immune-tolerant children with chronic hepatitis B who are walking around with sky-high viral counts. Hepatitis B virus is incredibly infectious and can survive on surfaces for up to 7 days.
I am also a parent of two little girls under the age of 2. I understand the view of parents who want to have a conversation about the risks and benefits of vaccines. I have fully vaccinated my children on the AAP recommended schedule, as I will continue to do throughout their lives. In my opinion, it is the most important thing that I can do to protect them.
I think that it is INCREDIBLY irresponsible of pediatricians such as Dr. Sears and friends to declare themselves “expert” and to develop an alternative vaccine schedule. They are exploiting the anxiety of well-meaning parents for their own notoriety and financial gain.
DrV, why so judgmental? I for one don’t advocate an altered schedule, but I am willing to work with people who want one. Parents are entitled to good information to make their own best decisions for their families, regardless of whether we think we know better.
Viki, here are a couple more answers:
I don’t know anyone who advises against MMR. However in the rare cases of family history of mitochondrial disease, multiple siblings with autism, or strong family history of autoimmune disease, there is some fairly controversial evidence that delaying MMR may reduce an individual’s chance of developing said illness.
Yes, low vaccination rates in the UK led to a measles epidemic. There was a recent cluster of measles in the US as well among an unimmunized religious sect.
It is true that hep A doesn’t cause severe liver disease. It can be highly unpleasant, and a real pain, but you won’t need a transplant from hep A. In fact, if you don’t get hep A vaccine at 12 and 18 months per the normal schedule, there IS NO CATCH UP SCHEDULE recommended. If my patients want to minimize vaccines, hep A is one I am ok with them putting off – as long as they have no plans for foreign travel or other risk factors.
Hep B is not a risk in newborns as long as mom has been screened and is known not to be a carrier, so that one can be delayed relatively safely as well.
Polio? Bad illness. But no wild type disease in the US in the past decade, so again, not as urgent to vaccinate at 2 months for a family who is unwilling to do more than a couple of vaccines.
There is no doubt that pertussis, H. flu, and pneumococcal disease can be life-threatening in very young kids; accordingly even those of us who will accomodate altered schedules strongly encourage those at 2, 4, and 6 months old with boosters on schedule.
As for the rest, I don’t know anything about the Dr. Tenpenny stuff. If I were in Peru I would not recommend delaying vaccines however! And I have never seen any convincing study showing a link between bowel disease and ethyl mercury. And, as you know, the autism rate has INCREASED since thiomersal was removed from vaccines, making the whole autism/leaky gut/mercury theory even less credible.
I am a pediatrician in private practice in an affluent community where many families wish to follow alternate vaccine schedules, and I often can not tell them what vaccines to give when. Every vaccine in the CDC schedule is important, and while many vaccine preventable diseases are currently in our backyards, others are just a plane flight away.
I trained in the last decade and remember at least three cases of infants on ECMO with pertussis, one of whom died, during my 2 months in the ICU. I remember the 4 month old who auto amputated her toes after severe dehydration from rotavirus that lead to a clot in her femoral vein which extended into the IVC. I remember the 9 month old who had a stroke, a complication of pneumococcal meningitis, and the 2 month old who was continuously seizing despite our best efforts from pneumococcal meningitis as well. There were too many children to count who died from complications associated with flu. The 2 year old who was encephalopathic while awaiting a liver transplant after a hepatitis A infection might disagree with DrZ as to whether or not Hepatitis A causes severe disease. Although I did not see tetanus or polio or HiB, my attendings had. And I will never forget the grand rounds of the child with late complications of measles because I honestly thought that those things didn’t happen in this country.
I too think that it is shockingly irresponsible for pediatricians to declare themselves as “experts” and appear on daytime television shows questioning the safety of vaccines, especially when they are peddling their own books or unstudied vaccine schedules. Dr. Gordon, with all do respect, if you haven’t seen a case of pertussis requiring hospitalization since 1994, then either you do not see enough patients or you live in some bizarre magical bubble that is being protected by a well vaccinated herd surrounding it.
I am always open to discussing vaccines with my patients because I want them to know that the best science we have proves that vaccines are perhaps the most important medical breakthrough of our lives. And for my baby girl, I hope that those that question that vaccines are safe and effective will open their eyes and review the science and their immunology texts so that my child, who is vaccinated, will not see these horrible preventable diseases return in her life.
Thank you, Dr. Swanson, for being a calm voice of reason and for discussing vaccines!
As a non-physician, I am greatly enjoying this exchange! I think it’s a dream of many parents to eavesdrop on physicians discussing an important issue like vaccinations.
We have followed all the standard recs for vaccinating our kids. Interestingly, I have yet to meet a parent who was NOT vaccinated as a child, but they still choose to skip vaccinating their kids. I find that ironic. “Yes, I was protected from many illnesses due to my childhood vaccinations, but I think they are too dangerous for my own children!” REALLY? Interesting logic.
I LOVED Dr. K’s analogy of skipping vaccines to skipping the car seat. So true.
I look forward to reading more discussion and seeing the “trilogy” posted soon, Dr. S!
Dr. Gordon has made a career by pandering to the anti-vaccine crowd. I do not doubt his sincerity, just his understanding of the facts. I find it hard to believe that he has not seen vaccine preventable diseases. I finished residency 11 years ago and have seen many. Like others have said, I also took care of a 6 week old infant that was on ECMO and went on to die from a pertussis infection she got from her father. Last year we had a 2 year old in our practice, whose parents wanted to take the “slow and careful” approach, who got pneumococcal meningitis. He survived, but is deaf for life. I would expect any pediatrician to have enough of a science background to understand the data, and avoid using personal anecdotes to dictate policy. I would not suggest that because I have not seen a case of HiB that it isn’t important to prevent, any more than I would suggest the diseases I have seen are the ones needing more treatment. We need to look at global incidence to protect our children.
I never turn a family away from my practice for refusing or delaying vaccines.
I have a 2 minute talk for parents. It comes up often. I totally understand parents questioning vaccines. They have been told by Dr. Gordon and others that vaccines cause all kinds of disease. If you search on the internet you will find people (like the ever FOS Dr. Tenpenny) who say vaccines cause diabetes, epilepsy, SIDS, ADHD, MS, cancer, autism, Parkinson’s disease, shaken baby syndrome, learning disabilities, IBD, lupus, allergies, arthritis, eczema, death and more. I think Frank Swain said it more clearly than I could, in his recent blog at scienceblogs.com.
“When mothers decide to not vaccinate their children, they are choosing to do so with only the very, very, very best intentions in the world. That they’ve been lead to believe not vaccinating is the best thing for them does not mean that they are stupid, evil, ill-intentioned, moronic. They’ve just been told a better story by ‘the other side’.”
We need to develop a relationship with parents that is based on trust. We do not recommend vaccines to make money. We do not recommend vaccines because “Big Pharma” tells us to. We recommend vaccines because we care about our patients and want to protect them.
Kathy, that’s an excellent point. Shortly before becoming pregnant, I traveled to a 3rd world region and required the entire CDC adult schedule plus typhoid and malaria. As a child I had standard vaccines plus TB and smallpox. I think if I need 1-2 more to collect the whole set. 🙂 So when my 8 week old baby developed an 104 fever for several days, I was really looking to make the schedule easier for her to tolerate. It didn’t seem fair that I could shrug about the person with measels at the local Fred Meyer, and she’d have a handicap until adulthood.
Dr JR: was the father of that 6 week old current on his TDAP booster? One thing you read from the anti-vax side is that folks who have the vaccine can still get a milder form of the disease. Why they won’t get very ill, they can spread it. The claim continues that pertussis levels rise and fall at regular cycle even among vaccinated populations. I’ll still take the milder illness. But the small infants are screwed till they have enough doses to gain the same level of protection.
I’m also enjoying the discussion and have learned a lot. I hope we collect the whole Dr alphabet as others join in. 😉
This is a great thread to read. However, as a mother of a son who contracted pertussis at 10 months, I have a different perspective. I was very frustrated with the lack of education from the Pediatricians who mis-diagnosed him. I had 2 Pediatricians in my clinic (mine was out sick) and one ER Doctor mis-diagnose my son with Croup, a cold and the ER Dr said it was Reactive Airways when I kept telling him it sounded like WC, he sent us home with a script for albuterol. (what a joke!) I still wish I would have been home when he called to confirm the positive WC test. I wanted to tell him his unprofessional attitude was not ok. So with all that runaround it took 7 days before we could get meds for my son. He had WC for 4 months, not once was he hospitalized or very ill. It was just a persistent cough that sounded horrible at times.
I wish more adults realized that immunity can wear off in your 30’s, 40’s & 50’s and everyone had their titers checked during their yearly physical. I also wished Doctors would only carry the Tetanus/Pertussis combo shot for adults. (Yes, I had mine 3 years ago)
Jay Gordon says
I believe that my response may have subverted the intent of Seattle Mama Doc’s original idea. I don’t want to do that.
The version I have for the five-year-olds is the simplest and can be tailored for any age group: “If you get this tiny shot now it might stop you from getting a big sickness.” The adult version would be quite different but not easily summarized in two minutes: “Whatever risks there might be to vaccination or any other medication or medical intervention, measles and polio didn’t disappear from America by magic. The reason we have virtually no measles in America and haven’t had wild polio since 1979 is because vaccines work extremely well.”
Dr. Vartabedian’s points are well taken and I have no desire to engage in an unpleasant exchange about a topic this important. Both he and I are guests here.
Parents are very concerned and they understand that the vast majority of pediatricians and experts support the current vaccination schedule and that opinions like mine about delayed or deferred vaccines represent a small minority.
To answer one of the questions, I recommend against the MMR. I have never liked the idea of three live virus vaccines given all at once. I refer DrV and others to the yellow fever vaccine literature. I’m not certain that the three antigens work well when given together and whatever risks are involved—and there may be none–are not warranted for the small benefit to an individual child. But this also flies in the face of the opinions of 99% of experts and the best advice you’ll get will be from a pediatrician willing to sit and talk with you. Not from me.
Mercury is toxic in all forms. In 1999, Dr. Neal Halsey, whose life has been dedicated to increasing vaccination rates in the best interest of children, led the official movement to remove thimerosal from vaccines. Dr. Halsey, MD is a pediatric infectious disease a Professor of International Health and Director of the Institute for Vaccine Safety at Johns Hopkins.
Counties in California with highest vaccination rates and those with the lowest vaccination rates have similar pertussis incidence. This set of bacterial illnesses, B. Pertussis and B. parapertussis, will not be eradicated. Vaccines keep the outbreaks in check, though.
Alternative vaccine schedules have no research to support them. Very few pediatricians or vaccine experts want to adjust the current schedule. Again, the risks to vaccination remain unproven and speculative but the benefits from wide-scale vaccination are proven and acknowledged. I would disagree about Dr. Sears: He’s well informed and has grown up knowing about vaccines.
Hepatitis B vaccination is crucial in high-risk situations and is also a good public health measure. The question asked me is why would we give that vaccine to a baby whose mother is hepatitis B negative? Hepatitis A is the least dangerous of the three (A, B, C) but that vaccine may be very valuable to certain families.
Dr. Tenpenny’s vaccination opinions are extreme.
DrK, I trained at Children’s Hospital of Los Angeles and saw many terrible illnesses caused by illnesses we can now prevent. In a tertiary care center these illnesses look far more common than they really are. Nonetheless, the decision to delay or defer vaccines can still be an individual decision. And, I would disagree about the schedule being designed to maximize protection. There are insurance constraints against five visits for five vaccines and logistical issues in a doctor’s office mitigating against spreading out vaccination. Those factors play into the scheduling of five or six vaccines at one check up.
Dr.JR, I think you have me confused with someone else. I think it’s very likely that vaccines, like so many other things we doctors do, have side effects and that very rarely there can be major side effects. Overstating this part of the issue polarizes and leads to no discussion at all.
Dr. Gordon continues to misinterpret history. Dr. Halsey admitted removal of the thimerosal from vaccines was handled poorly. All forms of mercury are toxic just like all forms of alcohol are toxic. That does not mean we should set safety standards for beer and wine (ethanol) based on the toxicity of Indy 500 fuel (Methanol). The toxicological analogy is appropriate and your statements about the mercury that was in shots (a decade ago) only perpetuate rumor and innuendo. You have also misinterpreted the motivation of the schedule. Do you really think if it was safer and more effective we wouldn’t all pick “spread out” schedule? If you think about it we would benefit by multiple visits. Each one with a copay and a primary administration fee would increase revenue. However, it is not in the best interest of the child. The difference between a child getting one and three injections at once in minimal. A child getting one injection on three occasions a month apart is unnecessary and more traumatic. You talk about vaccines like they are a black box with unknown ingredients and mysterious and dangerous effects on the body. We actually know exactly what is in them. The demand on the immune system is almost insignificant. The number of antigens the body has to respond to is nothing compared to the work it has to do every day to keep a child protected from the germ covered environment.
I must admit you and Dr. Sears have worked very hard to set yourselves apart. You have succeeded in undermining the public’s confidence in our vaccine system. Congratulations! I just wish it didn’t come at such a high price.
Dr. Jay writes: “Hepatitis B vaccination is crucial in high-risk situations and is also a good public health measure. The question asked me is why would we give that vaccine to a baby whose mother is hepatitis B negative?”
How reliable is the screening test for hep B?
Wendy Sue Swanson, MD says
We give Hepatitis B vaccine to ALL babies, regardless of a mother’s Hepatitis B status. This is to prevent Hepatitis B from any exposure throughout their lifetime, not just their exposure in-utero or passing through the birth canal.
Hepatitis B vaccine is used as a preventative measure (when given to healthy babies), not “treatment” for babies at high risk of the disease. Vaccinations aren’t treatments; rather, immunizations/vaccines prep and teach the immune system to prevent infection once babies and children are exposed to the viruses or bacteria later in life. Then when a baby or child encounters an illness (like chicken pox, or Hepatitis B, for example) that they have been immunized against, they have a ready immune system available to fight of infection and prevent its presentation. It’s precisely why vaccinated children can sometimes get an illness they are immunized against, but often, the child has a much milder course of infection. Their immune system is already primed and ready to take care of it…
Although you’re right in your thinking, if I understand your question correctly, that babies born to a mom with Hepatitis B are at much higher risk for acquiring the infection.
Screening Hepatitis B titers for mothers (tests to look for antibodies to the infection) are very reliable for Hepatitis B infection. Only concern can be if a mother contracts Hepatitis B between the screening blood test and a baby’s birth or at just at the time of the blood test where the immune system wouldn’t yet have responded. If mom had negative test, then got Hepatitis B infection (from sex, sharing of bodily fluids, or intimate contact with an Hep B positive person), she could get the infection and put the baby at risk. Therefore the screening test could be negative and the baby could have been subsequently exposed.
Babies born to mothers with Hepatitis B are usually treated more aggressively with HBIG (Hepatitis B Immunoglobulin) and Hepatitis B vaccine immediately after birth. HBIG is also used in these situations as prophylactic treatment to reduce the likelihood of acquiring the infection:
1) perinatal exposure of an infant born to an HBsAg-positive mother,
2) inadvertent percutaneous or permucosal exposure to HBsAg-positive blood,
3) sexual exposure to an HBsAg- positive person,
4) household exposure of an infant 12 months of age to a primary care-giver who has acute hepatitis B.
For an infant with perinatal exposure to an HBsAg-positive and HBeAg-positive mother (2 different antibodies), a regimen combining one dose of HBIG at birth with the hepatitis B vaccine series started soon after birth is 85%-95% effective in preventing development of the HBV carrier state
I agree completely with Dr. Swanson’s comments above. As I mentioned before in my earlier comment, as a pediatrician who is a gastroenterologist who is trained in hepatology, I treat children with liver disease, and that encompasses a fair number of children who are chronically infected with Hepatitis B. Hepatitis B is a terrible disease that once contracted is incurable, and is the 10th leading cause of death worldwide.
“The question asked me is why would we give that vaccine to a baby whose mother is hepatitis B negative?”
I believe that this statement by Jay Gordon is misinformed and shortsighted. The point of the vaccine, as detailed by Dr. Swanson above, is not only to protect the child of a Hepatitis B-infected mother in the perinatal period, but also to protect that child from a dangerous, extremely difficult to treat infection that is not rare. Granted, infection rates are lower here than in Asia, Africa, and Europe, but with globalization and immigration, we are seeing certain communities with extremely high rates of infection in the US.
“Hepatitis B can be contracted through inadvertent percutaneous or permucosal exposure to HBsAg-positive blood.”
What parents should take away from Dr. Swanson’s statement is this: You have no way to predict when your child may be exposed to a serious infection such as Hepatitis B. Any apparently harmless shared toothbrush, razor, exposure of a small cut or scrape of the skin to Hepatitis B-infected blood is a risk. Most individuals with chronic Hepatitis B appear well until decades down the line. The ONLY way to protect yourselves and your children is through immunization.
Melissa (Confessions of a Dr.Mom) says
Great discussion here Wendy. I’m looking forward to hearing these 2 minute representations of vaccines. As you know, I spread out the vaccines for my second child. Not because I don’t believe in vaccines, I certainly do. It was a personal decision based on personal experiences. My child is fully vaccinated and has been since the age of 2, I just decided not to give her the shots all at once.
That being said, yes the vaccine guideline is important and timeliness of vaccines is important. However, I am open to discussion with parents. It helps to open up this dialogue and by acknowledging potential risks I think it makes parents sitting on the fence more apt to listen to what we have to say about vaccines and more willing to keep an open mind about vaccinating their child.
We don’t want to alienate those families who are unsure about vaccinating, so I sure hope this dialogue helps to open up the communication and understanding on both sides so that our end goal is the same: protecting our children’s health.
You got it right when you said vaccinating our children really ends up being an emotional decision. Parents and pediatricians alike just want to do what is right for their children so I think this open dialogue will help parents make an educated decision.
Wendy Sue Swanson, MD says
Thanks for your comment, Dr. Melissa. One quick note on what you said:
I agree that being open (to discussion, to taking time to listen to a parent’s perspective, to different viewpoints) remains essential in helping families care for their children and in helping families understand the vaccine schedule.
Believing in the AAP immunization schedule (and the science that backs it up) while also being a compassionate, effective communicator, are not mutually exclusive. Often in discussions like this I feel that physicians who believe in the AAP schedule are projected against those doctors who know how to listen and help families understand.
We can do both. And I believe the distinction is an important one to make.
Melissa (Confessions of a Dr.Mom) says
Yes, great point Seattle Mama Doc 🙂 I do believe we can do both. That is a very important distinction.
I’ve been pondering this discussion in the last few days, using myself as a litmus test. I’m questioning whether I would do anything different with my (possible, future) third child than I did with my first two. When my 1st was a baby the CDC pamphlet said 10% of babies had an fever > 102, and 5% had a fever >=104. It was comforting to know that it was documented and those kids aren’t harmed. (And mine wasn’t harmed.) Whatever the gene is that puts you in the 10% or even 5%, both my kids have it. So did 1 of my nephews, a niece, and a handful of kids in our playgroup. Why do these kids have more inflamation and would you still recommend Tylenol in this case? With my daughter we had to do Tylenol till 6 months, when we got frustrated and starting giving her only 1-2 shots. With my son we did 1 shot at a time 1x per month till 6 months and 2 after and he sailed through without any meds. Which of these children has better protection from the diseases?
I remember going a current events project on the “Bubble Boy” in grade school. I understand that our immune systems react to billions of germs each day. So I get why Dr Offit made the 10,000 vaccines remark. But that remark also frustrates me because all germs are NOT created equal. If m/ m/ and r were just like rhinovirus we wouldn’t need vaccines. My girl had a low grade fever for 10 days starting a few hours after her MMR (again, normal and safe, per CDC documentation). I can count maybe 4 times she’s had a fever from a cold. I feel these sorts of statements trivialize the vaccines.
I love that the person who started this asked if you “believe” in vaccines, as if it’s a religion or something made up that you have to put faith in, in order for it to work.
To me, the phrasing of the question alone indicates a gross misunderstanding of the topic that, unfortunately, is likely pervasive with many parents across the nation who have only visited the church of Jenny McCarthy on the topic.
Trinity McDermott says
Seattle Mama Doc,
Great blog! I have a mom’s playgroup in Bellevue with about 30 active moms and kids (about 40 more struggling to be more active) and I’m sharing this information with them. While I’m open to the idea of spacing out vaccinations a bit (seems the only main down sides are more time on the part of the nurse and families, right?), but I do support vaccinating children. It’s the reason polio and smallpox are not concerns for us in the US. I hope that does not change. I look forward to reading more about you and your interests.
Seattle Mama Doc,
Great post! Thank you so much for bravely putting the question out there. I have already forwarded it to many friends with young children. Growing up outside the Pacific Northwest and moving to Seattle a few years ago, I was stunned at the amount of anti-vaccine talk I heard among friends and play groups. I never even once considered NOT vaccinating my 1 yo daughter. It seems completely irresponsible to me as a parent and yet smart, educated parents have confided in me that they are concerned about the links with autism. How is it possible that medical myth can spread so effectively? The American Public needs to stop taking medical advice from the 1994 Playmate of the Year and star of MTV’s Singled Out and instead refer to the AAP and other trusted sources.
One question I have relates to vaccination rates among regions of the US. Is the vaccine debate more prevalent in Seattle? Have they studied the % of vaccinated children based upon regions of the US? Is this more of an issue in Seattle vs. New York or other areas? Thank you again for sharing this valuable information. It is an excellent platform to share with others and the comments have been very worthwhile. Thank you!
I have a 13 year old with Autoimmune hepatitis and a 20 month old. should I give any live vaccinations to my 20 month old? My 13 year old is on Prednisone and Azathioprine which im sure you Docs are aware of is a immune supressant drug.
I just wonder why we have 36+ vaccines when it used to be about 10? How come other countries don’t vaccinate until their children are older, and have less vaccinations, and we’re the sickest of them all? How come the Amish don’t vaccinate and we don’t hear of any massive outbreaks or high death rates for their children? How come people always use the Autism argument when there are other neurological problems associated with vaccines such as ADHD, guilles Barr (sp). Are peanut allergies due to the peanut oil in vaccines? Are ear infections linked to vaccines? If kids are vaccinated what do they have to fear from unvaccinated kids? They should be protected right? What are the actual numbers of children damaged from being vaccinated? VAERS has that info right? How accurate are their numbers? How come they don’t do a test on how the vaccines work together? I’ve read that they’ve only tested the individual vaccine not the cocktails kids receive. Is that true? How long are the vaccines effective for? How come vaccinated kids still get sick from the diseases they are vaccinated against? Why is there an adult schedule? I’ve never had adult vaccines am I at serious risk? Did we really ship all of our thimerisol vaccines to third world countries? Are we going to start seeing autism and our other problems show up in relatively autism free countries? Do we have more autism than other countries that vaccinate less?
As a parent who hasn’t yet vaccinated these are some of my questions. I believe in the idea of vaccinations, but I know several kids who have been damaged by them. I don’t believe we do it safely, and I don’t think enough research has been done since they’ve added so many at once.