Friday, March 6, 2009

Should I Vaccinate My Baby?


This is the question I am daily asked when seeing my newly born neonate patients. During the past three years I have noticed a progressive fear towards vaccines that seem to be overcoming my new mothers. Being that I see the babies that I deliver for the first couple of months, I have made an effort to more adequately understand vaccines. Here is some interesting information that I have learned. Before I start, I must give a disclaimer and say that I respect and believe that everyone has the right to their own opinion.

I have often wondered where and when vaccines came about. There is kinda a funny story as to where the name "vaccine" actually came from. Vaccines all started in the 1700's with Edward Jenner and a milkmaid. Jenner noticed a relationship between the disease known as "grease" and a disease known as "cow pox." He saw that farmers who treated horses with grease lesions often saw the development of cow pox in their cows, complete with blisters similar to those seen in smallpox infection. Unlike lethal smallpox, however, the cowpox blisters eventually disappeared, leaving only a small scar at the site of each blister. Jenner became intrigued when a milkmaid told him that she could not catch smallpox because she had had cowpox. Jenner then began to notice that there were many people like the milkmaid. With this in mind, Jenner undertook a daring experiment in 1796: he infected a young boy with cowpox in hopes of preventing subsequent smallpox infection. After allowing the boy to recover fully from cowpox, Jenner - in an experiment that would be considered unethical by today's scientific community - intentionally infected the boy with smallpox by injecting pus from a smallpox lesion directly under his skin. As Jenner had predicted, the boy did not contract smallpox.

Ok lets fastforwad to 1999- a cable news network aired a program on which the parents of three-year-old stated that he had developed autism two weeks after receiving measles, mumps and rubella (MMR) vaccine. An American Academy of Pediatrics official explained why there was no reason to believe that a link exists between autism and vaccination. However, dramatic before-and-after videotapes of the child probably had enough impact to persuade many parents to avoid having their children vaccinated. The program's narrator stated there had been "a puzzling jump in the number of children being diagnosed with autism." However, the number being diagnosed may reflect increased reporting of cases rather than an increase in actual incidence.

Some parents of children with autism believe that there is a link between measles, mumps, rubella (MMR) vaccine and autism. Typically, symptoms of autism are first noted by parents as their child begins to have difficulty with delays in speaking after age one. MMR vaccine is first given to children at 12-15 months of age. Since this is also an age when autism commonly becomes apparent, it is not surprising that autism follows MMR immunization in some cases. However, the most logical explanation is coincidence, not cause-and-effect.

If measles vaccine or any other vaccine causes autism, it would have to be a very rare occurrence, because millions of children have received vaccines without ill health effects. The only evidence linking MMR vaccine and autism was published in the British journal Lancet in 1998. An editorial published in the same issue, however, discussed concerns about the validity of the study. Based on data from 12 patients, Dr. Andrew Wakefield (a British gastroenterologist) and colleagues speculated that MMR vaccine may have been the possible cause of bowel problems which led to a decreased absorption of essential vitamins and nutrients which resulted in developmental disorders like autism. No scientific analyses were reported, however, to substantiate the theory. Whether this series of 12 cases represent an unusual or unique clinical syndrome is difficult to judge without knowing the size of the patient population and time period over which the cases were identified. If there happened to be selective referral of patients with autism to the researchers' practice, for example, the reported case series may simply reflect such referral bias. Moreover, the theory that autism may be caused by poor absorption of nutrients due to bowel inflammation is not supported by the clinical data. In at least 4 of the 12 cases, behavioral problems appeared before the onset of symptoms of inflammatory bowel disease. Furthermore, since publication of their original report in February of 1998, Wakefield and colleagues have published another study in which highly specific laboratory assays in patients with inflammatory bowel disease, the posited mechanism for autism after MMR vaccination, were negative for the measles virus.

Hmm...
One question I am asking myself...the known number of Autism cases has been increasing since 1979, but why was there no jump after the introduction of MMR vaccine in 1988? Interesting food for thought..

Ok, so now..what about the Diptheria, Tetanus, and Pertusis vaccine? And the oral polio vaccine? In January 1990, an Institute of Medicine committee examining possible health effects associated with DPT vaccine concluded that there was no evidence to indicate a causal relation between DPT vaccine or the pertussis component of DPT vaccine and autism. Also, data obtained from CDC's Monitoring System for Adverse Events Following Immunization system, showed no reports of autism occurring within 28 days of DPT immunization from 1978-1990, a period in which approximately 80.1 million doses of DPT vaccine were administered in the United States. From January 1990 through February 1998, only 15 cases of autism behavior disorder after immunization were reported to the Vaccine Adverse Events Reporting System. Because of the small number of reports over an 8-year period, the cases reported are likely to represent unrelated chance occurrences that happened around the time of vaccination.

Ok...so now I guess you are thinking I am hard core on vaccinations! Actually, I prefer the more middle of the road approach so to speak....I believe vaccines are very important and have played a tremendous role in limiting many serious diseases in our country. However, more and more parents are concerned and want to take an approach that varies from the regular CDC schedule. I believe that if more and more doctors offer parents such options, we will have better vaccination rates than we are seeing now. Some options for parents...

Don’t give the Hepatitis B vaccine to newborns in the hospital.This shot can cause fever, lethargy, and poor feeding (problems you don’t want to see in a newborn),one could delay this shot until the first two months of life, especially since the disease doesn’t even occur in newborns (it’s a sexually-transmitted disease).

Checking “titers” (blood immunity levels) for various shots before doing boosters. Some kids don’t need some of the booster shots at age 5 years because their original infant series may still be working just fine. While this is a costly and time-consuming approach, some parents prefer it instead of automatically getting all the boosters.

Getting fewer shots at each infant checkup and spreading the shots out over more time. This is the hallmark of Dr. Sear's Alternative Vaccine Schedule. I reallllly like this schedule! The MMR is the most criticized culprits of autism, but this schedule divides them up at 1, 2, and 3 years old.

Limiting large combination shots. Some parents prefer to split some of the combo shots into separate components to decrease the chance of a reaction. While we don’t know if this precaution even helps, it is an option that some doctors like to provide for concerned parents.

The bottom line is that more and more parents want options. If we don’t provide them with options they are comfortable with, more parents will opt out of vaccines altogether. We will then see more and more disease fatalities and complications.

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