The Today Show was recently at Four Seasons Pediatrics filming a segment on vaccines and our vaccine policy.  This segment should be aired September 1st between 8-9 am (tentative to being pre-empted by breaking news).  We will tweet any updates about this. 

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Dr. Miller Comment:

Over the past few years, we were seeing a decline in the number of children being vaccinated, with an increase in delaying vaccines, splitting vaccines and picking and choosing which vaccines to comply with.   We believe that the diseases that we vaccinate against have not gone away.  They can and will and have made comebacks.  Witness the Pertussis outbreak with more cases than than California has seen in 50 years and 10 infant deaths under 3 months of age.  There are more cases of measles that have been seen since the 90’s. 

It is important to understand the concept of “Herd Immunity”.  Approximately 95-97% of children will develop immunity to any given vaccine.  The other 3-5% are still protected WHEN approximately 90% of the population is vaccinated.  When most of us are vaccinated, this LIMITS the spread of disease, making it harder for the disease to find the person(s) who never developed immunity.   When the community vaccinates less, we all are affected.

The providers in our practice, felt it was important to protect this concept of herd immunity within our practice.  Our policy affected only 0.5% of our practice.   The small number of people who do not vaccinate, refer to vaccines as a toxin or poison.  We found that studies that are well done, along with our recommendations will not affect their views on vaccines.  They are very loud and well organized and the media tends to focus on them.  This leads to much confusion to the majority of parents who really want to do what’s best for their child, but are paralyzed from making a decision that is best based on the thousands of studies that show vaccines are safe and effective. 

Our Vaccine Policy was developed in February 2010 after much thought and consideration.  It is not an “In Your Face” Policy and many parents may not remember the letter we sent out at that time.  Most parents are not aware of the policy, as they choose to vaccinate.  This policy affected 1/2 of 1% of our practice when it was enacted.  We want to assure you that we listen to your views and concerns.  At that same time, our first priority is to do all we can to prevent illness in the children in our practice.  We wanted to make a statement that shows how confident we are in our view that vaccines ARE the most important medical treatment that we can recommend for your child, and that you can do as a parent.  The sickest children come to see us in the doctors office.  The doctors office has been and will be the source for spread of some of these infections.  We  do our best to reduce your chance of infection in our office.  We have two separate waiting rooms.  You will also find hand sanitizer stations throughout our office.   Despite these precautions, parents will want to bring their children in when they are sick.   In the end our vaccine policy is not about those who do not vaccinate.  It is about those who do.  Children are our most precious assets.  We at Four Seasons Pediatrics, want to do all we can to protect them.  Our vaccine policy is consistent  with this principle.

Sincerely,

Dr. Harry Miller and Dr. Kimberly Elmer

September 1st Update:

The link to the story on the Today Show is here:

http://today.msnbc.msn.com/id/26184891/vp/44355062#44355062

We want the greatest health and safety for the children we care for in our practice

1. In the past year, there has been a steady increase in the number of parents choosing to not vaccinate, to follow their own schedule and or delay vaccination
2. There have been pockets of increased vaccine preventable diseases in the United States.  Many of these pockets have involved un-vaccinated children as a strong component of these surges in disease.
3. Well funded, well polished Anti-Vaccine Groups have continued to re-cycle non evidence based hype regarding vaccines lending confusion to this issue.  This emotional appeal to parents leads to confusion and is a disservice to well intentioned parents who want to do what is best for their children.  It needs a strong un-equivocal statement from doctors to show confidence in vaccination.
4. School policy has traditionally been consistent with the principle that the needs of the many outweigh the needs of the few.   Therefore schools have required children to be vaccinated to attend with few exceptions.   We believe this approach to be appropriate.  We believe it is also medically appropriate to exclude un-vaccinated children from a pediatric practice to protect the vaccinated children from communicable infectious diseases.

With these issues in mind, the following reflects our vaccine policy

Four Seasons Pediatrics Vaccine Policy Statement

• We firmly believe in the effectiveness of vaccines to prevent serious illness and to save lives.
• We firmly believe that parents want their children safely protected from infectious diseases.
• We firmly believe in the safety of our vaccines, though we understand that they are a drug.
• We firmly believe that all children and young adults should receive all of the recommended vaccines according to the schedule published by the Centers for Disease Control and Prevention and the American Academy of Pediatrics.
• We firmly believe, based on all available literature, evidence, and current studies, that vaccines do not cause autism or other developmental disabilities. We firmly believe that thimerosal, a preservative that has been in vaccines for decades and remains in some vaccines, does not cause autism or other developmental disabilities, although none of the vaccines we use contain thimerosal.
• We firmly believe that vaccinating children and young adults may be the single most important health-promoting intervention we perform as health care providers, and that you can perform as parents/caregivers. The recommended vaccines and their schedule given are the results of years and years of scientific study and data gathering on millions of children by thousands of our brightest scientists and physicians.
• We firmly believe that public health policy excluding un-vaccinated children from school is appropriate for a school setting, and is also appropriate at this time in our office setting.   The sickest children are seen in a doctors office and can be a source of spread of infectious disease to patients.
• We firmly believe that much of the protection of vaccines comes from herd immunity.  Most vaccines produce immunity in 90-95% of children.  The remaining 5-10% who do not produce immunity are protected from herd immunity, meaning that a highly vaccinated population limits the spread of most infections.  As more people choose not to vaccinate, herd immunity is eroded.  Now more than ever, it is important to protect parents who choose to vaccinate their children from those who do not vaccinate.
• We firmly believe that we have spent hundreds of hours educating parents individually, in the community and through a series of articles on our website.  Our education has been solidly founded on evidence.

These things being said, we recognize that there has always been and will likely always be controversy surrounding vaccination.  Indeed, Benjamin Franklin, persuaded by his brother, was opposed to smallpox vaccine until scientific data convinced him otherwise. Tragically, he had delayed inoculating his favorite son Franky, who contracted smallpox and died at the age of 4, leaving Ben with a lifetime of guilt and remorse. Quoting Mr. Franklin’s autobiography:

“In 1736, I lost one of my sons, a fine boy of four years old, by the smallpox…I long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it, my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.”

The vaccine campaign is truly a victim of its own success. It is precisely because vaccines are so effective at preventing illness that we are even discussing whether or not they should be given. Because of vaccines, many have never seen a child with Hemophilus influenza, tetanus, whooping cough, bacterial meningitis, or even chickenpox, or known a friend or family member whose child died of one of these diseases. Such success can make us complacent or even lazy about vaccinating. But such an attitude, if it becomes widespread, can only lead to tragic results.

Over the past several years, many people in Europe have chosen not to vaccinate their children with the MMR vaccine after publication of an unfounded suspicion (later retracted) that the vaccine caused autism. As a result of under-immunization, there have been outbreaks of measles and several deaths from complications of measles in Europe over the past several years.  These outbreaks are now becoming more common here in the United States with more frequency and involving more diseases.  In a study based on nationwide surveillance data from 1985 through 1992, children with non religious exemptions were 35 times as likely to contract measles as nonexempt children.¹ In another study in Colorado based on data for the years 1987 through 1998, children with exemptions, as compared with unvaccinated children, were 22 times as likely to have had measles  and almost six times as likely to have had pertussis.²

Our policy is written to emphasize the importance of vaccinating children. We recognize that the choice may be a very emotional one for some parents. We will do everything we can to convince you that vaccinating according to the schedule is the right thing to do. Please be advised, however, that delaying or “breaking up the vaccines” to give one or two at a time over two or more visits goes against expert recommendations, and can put your child at risk for serious illness (or even death) and goes against our medical advice as providers at Four Seasons Pediatrics. We follow the recommendations of the American Academy of Pediatrics and its schedule, and as such do not recommend that parents pick their own schedule or follow schedules like the “Dr. Bob” schedule. 

Four Seasons Pediatrics follows the recommended schedule of the American Academy of Pediatrics.  Click here to view this schedule. 

If despite our recommendations, you feel you cannot follow the CDC and AAP recommendations for these vaccines, we will ask you to find another health care provider who shares your views.   We do not keep a list of such providers, nor would we recommend any such physician, any more that we would recommend a doctor who prescribes antibiotics by request. This approach does not include parents who choose to not vaccinate for certain vaccines based on firmly held religious beliefs.

As medical professionals, we feel very strongly that vaccinating children on schedule with currently available vaccines is absolutely the right thing to do for all children and young adults.   We want your trust and will work to earn it.  Thank you for your time in reading this policy, and please feel free to discuss any questions or concerns you may have about vaccines with any one of us.

1. Salmon DA, Haber M, Gangarosa EJ, Phillips L, Smith NJ, Chen RT. Health consequences of religious and philosophical exemptions from immunization laws: individual and societal risk of measles. JAMA 1999;282:47-53. [Erratum, JAMA 2000;283:2241.]

2. Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE. Individual and community risks of measles and pertussis associated with personal exemptions to immunization. JAMA 2000;284:3145-3150.