Parents Corner
To Vaccinate or Not?
Parents Worry About Safety
By Anita Manning in USA Today.
"If you're 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 wouldn't happen to me. Or to my daughter."
-- Anne Marie Worthy
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, 'I'm 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 mother's 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 epiglottitis,
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 Worthy's 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 you're 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 wouldn't 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 year's 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.
"We've not yet seen an impact in our national data, as they
have seen in the United Kingdom, where they've 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 U.S. 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.
"What's happening in this country over the last 10 years is
that we've changed our definition of safety," says Paul Offit,
chief of infectious diseases at Children's 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."
That's 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."
That's 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 don't 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, it's 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 wasn't 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 CDC's 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 we're
going to have a problem." Peggy O'Mara, publisher of Mothering
Magazine, which promotes "natural family living," says many
readers question vaccines "from a philosophical point of view.
. . . People say it's the condition of the host that's important.
If a person is healthy, they're 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, O'Mara says, and they don't 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, N.J., has decided not to have her daughters, Isabel, who
will be 5 in August, and Olivia, 21 months, vaccinated.
"It's a big commitment, a big step," she says. "I've
worked as hard as I can to educate myself. I'm 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 -- she's 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 shouldn't
be tampered with. I'm not against medicine. I'm just trying to strengthen
and bolster the immune system naturally." She believes this is
the right choice for her daughters. "I'm sure most parents would
think I'm really crazy for questioning what the government or school
officials would ask of me," she says. "I'm just doing what
feels right. And I know there's a risk to everything." Healthy
kids are better equipped to fight off infection, Offit agrees. "It's
true that if you're very healthy, you're less likely to be overwhelmed
by a virus or bacteria than if you're 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.
"I've 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. We're willing to accept a negative
consequence given to us by God, but not one given to us by man.
Other useful resources
Drew Bledsoe of the New England Patriots has established
the Drew Bledsoe Foundation Parenting With Dignity
program. Bledsoe says of his success "my
parents helped me the most to be what I am today" and
his goal is to help other parents give their children the
best possible start. For more information, see http://www.drewbledsoe.com/.
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