By Sara Cherny and Denise Shepler
On Monday, when the first article about vaccinations was published, there was a great deal of conversation on our respective Facebook pages, mostly surrounding the issue of the timing of vaccinations, and the potential risks of offering too many vaccinations at one time. A good deal of the information about why physicians, parents, and public health officials might want to consider adjusting the timing of vaccines during infancy came from Denise Shepler, RN BSN. Denise has four years of experience in maternal/neonatal nursing. With her permission, I have summarized her thoughts here.
In general she says:
“Unfortunately this is the first real study that I have read on this topic, so clearly much more research and peer review is needed. However, the findings of this study show some concerning trends and results that should not be ignored by the health care community. It is easy to take for granted the idea that everything medicine has to offer only serves to increase quality of life and to lengthen lifespans, but there are many examples of excessive use of medical intervention having the opposite effect. This could easily be a prime example of such.”
First, she suggested that we read this scientific paper about the subject. The authors report a correlation between the infant mortality rate and the number of vaccines given at once in the first year of life. Countries that have a higher number of vaccines in a shorter amount of time are reported to have a higher infant mortality rate.
Denise expands on her position with the following information:
“Infants as young as 2 and 4 months are given 5-6 different injections in one visit, but since one of those injections is DTaP (the tetanus vaccines that also include diptheria, and always pertussis when given to children), that means 8-9 vaccine doses in one day. That also means that if that child has an adverse reaction to one of those vaccines, there is no way to tell which one it was and all of those vaccines must be avoided for the rest of that child’s life. If we spaced vaccines out over a longer period of time, kids’ immune systems wouldn’t be bombarded with that many antigens at once, and we could identify which, if any, vaccine caused adverse reactions and therefore only forego that one specific shot instead of half of them. I don’t disagree with vaccines, as they have definitely helped decrease and even eradicate instances of many infections, but I *do* disagree with the aggressive schedule.” (CDC Recommended Immunization Schedule 2010)
She goes on to make the following recommendation for all of us involved in the vaccine discussion:
“Dr. Robert Sears spent a decade researching every routine childhood vaccine and put his findings in an easy-to-read book. He breaks each one down and examines all the ingredients and compares each brand of each vaccine to each other. He discusses actual scientific findings and whether there is scientific evidence behind the common fears (such as autism). Additionally, he discusses the diseases themselves, how common they are (both in the US and overseas) and what happens if a child catches that disease. Finally, at the very end of the book, he prints the CDC recommended schedule, his own schedule for parents wishing to space the vaccines out, and a minimum “must-have” schedule for parents wanting to vaccinate as little as possible. I consider his book to be a must-read for anyone who wants to discuss the vaccine issue, as he presents his information in a non-biased and fact-based manner.”
The reason why so many vaccines are grouped together certainly comes from a public health perspective:
“Stick ‘em while you got ‘em” is the main reason why they do it that way. It’s a great idea for low-income populations who probably only go to the doctor/nurse practitioner when their child is sick, but for parents who keep up with their child’s scheduled health check ups, it’s certainly not ideal. If a parent wants to go with that schedule, that’s fine, but a lot of parents face pediatricians who threaten to call Child Protective Services on them if they decide to deviate from the CDC schedule.”
I responded to this, wondering if those physicians might be reacting to a fear of legal repercussions for not following CDC guidelines. Interestingly, this came up briefly in a different discussion about our article, in which someone stated that “doctors nowadays let you divide them.”
Denise felt that it was more than fear:
“The government can’t legally force any kind of treatment or intervention onto anyone and patients have the right to refuse anything and everything. Health care providers often forget that their patients are autonomous human beings with the right to make those decisions. In the health care field, it’s easy for us to adopt the, ‘I know better than you so you’ll do what I say,’ attitude. Threatening to call Child Services over a change in vaccine schedule is just the next threat we have after lecturing hasn’t worked.”
In order to inform myself more fully on this topic, I asked a general pediatrician, and a pediatric infectious disease specialist with whom I work for their responses.
The infectious disease specialist was skeptical about the article. He pointed out that infant mortality rate has an extremely large and diverse number of variables, including prenatal health care and prematurity rates. He suggested that a more informative aspect of vaccines to study might be the number of doses for a specific vaccine, and that studies should compare those that are vaccinated with those that aren’t within the same country to control for public health and cultural variables.
With regard to the CDC schedule, the infectious disease specialist strongly agrees with it. An adjusted schedule significantly increases the odds that a child will miss a vaccine, and this is not a risk that he feels comfortable with at this time, given that there is no other evidence for Dr. Sears’s schedule outside of Dr. Sears himself. Personally, I think it’s important to remind ourselves that it is certainly not just lower-income families who forget, cannot make it, or choose not to attend visits with their physician.
In cases where the parent wants to adjust the vaccine schedule, both the infectious disease specialist and the general pediatrician said that they would be amenable to the idea, although with a strong caveat that the patient will be expected to adhere to it. The general pediatrician stated that he would work out an acceptable schedule with them, offer nurse visits as an option for vaccines between doctor’s visit, and that he would keep a close watch so that they are caught up by next visit. His thought was, “at least they’re getting their shots”. If the other option is that the parent will refuse vaccination all together, then he is willing to compromise knowing that at least they get them. Neither physician would call DCFS (Division of Child and Family Services) for a family that does not vaccinate their children. (It may be relevant that Denise and I are in different regions of the country.) Both would continue to see the child in their practice, and, as one said “therapeutically pester them” about the benefits of vaccination.
This is all we’ve got the space for here on GH. Further discussion of this subject is something we hope you will take up with your respective pediatricians. Informed parents are better parents!
About the Author: Sara Cherny is a board certified genetic counselor at a major academic medical center. She has been in clinical practice for over four years and has special interests in public health and family communication.