Four Seasons Pediatrics

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Splitting and Delaying Vaccines

Why not split up the shots?

At Four Seasons Pediatrics, we want you to know that we want the greatest health and safety for the children we care for in our practice.  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.  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.  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.

We firmly believe in the effectiveness of vaccines to prevent serious illness and to save lives.  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 also 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 schedule of the recommended vaccines 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 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 children by vaccinating them.

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 have the luxury of considering whether or not they should be given. Because of vaccines, many have never seen a child with polio, 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 that the vaccine caused autism.  In an un-precedented move, the journal which published this study (Lancet) redacted its article on February 2nd, 2010 due to evidence that its lead author, Dr. Andrew Wakefield did not conduct a proper study regarding MMR.  Despite the scientific lack of evidence and the conflicts of interest that Dr. Wakefield has had, anti-vaccine groups have continued to defend his study.  As a result of this study leading to 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

Each vaccine given, is timed to give the most protection at a critical age to prevent the most devastating infections.   Getting more than one shot at a time isn’t a huge physical stress. Their immune systems handle far greater challenges from everyday exposure to germs on shared toys, doorknobs, and the playroom floor.  As Dr. Paul Offit explains it: Think about the bugs that caused your child’s last ear infection. Each single bacterium has 2,000 to 3,000 components that stimulate an immune response from the body. As those bacteria multiply, the challenge to the immune system increases exponentially. Your baby feels awful and likely has a high fever and lots of pain. The body pulls out the stops to fight it off. NOW COMPARE THAT TO THIS: “The entire fourteen-shot course of childhood vaccinations contains only about 150 immunological components altogether,” says Dr. Offit. This is about a tenth of the challenge posed by exposure to just one microscopic germ.

What’s more, the bacteria and viruses used in vaccines are either killed or altered, says Martin Myers, M.D., author of “Do Vaccines Cause That?!” There are just enough to induce immunity, but not enough to make someone sick — and certainly not enough to overload the immune system of a healthy child.  In rare instances, some susceptible children experience fever-induced seizures following shots, but though these are frightening, they cause no permanent harm.  These same fever-induced seizures can occur with any viral illnesses.

Splitting Up Vaccines: One common response to these concerns is to break up combination vaccines (which may contain up to five inoculations in one) or to spread them out. But that carries significant risks of its own. “Too often, an immunization delayed is an immunization missed,” says Dr. Schaffner. “It’s hard enough for parents to keep track.”   Coming in to the doctors office to “spread them out” increases your child’s exposure to illness.  Children with mild illnesses ride it out at home.  The sicker children are brought to the doctor’s office to be seen.  While this risk is small, why expose your child to more illness or to the illness you may be trying to prevent, by spreading out the shots.   Finally, there is not even one controlled study that shows spreading out the shots prevents anything.

More troubling, during the gaps, kids are susceptible to catching serious diseases they could have been protected from. Vaccines are scheduled when they are for precise reasons: It’s a balance between finding the time when the baby’s immune system can respond and knowing when he’s most in danger of catching the infection, says Dr. Schuchat. Give a shot late and a child is left unprotected at his most vulnerable time.

Why start so early?

The decision as to when to give a vaccine is based on the epidemiology of the vaccine preventable disease. Often, these diseases are more severe in younger children. Therefore, we start early to ensure that the youngest and often most fragile are protected as soon as possible.  For example, most deaths due to pertussis occur in infants younger than 6 months of age.

Please remember that immunizations have been a major public health success story. The vaccine schedule has evolved over the past 50 years based on scientific evidence.   It is your pediatricians job to constantly review this evidence.  Each vaccine must be judged on its individual merit and evidence of benefit.

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