Parents' choice or public health threat?
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|Tue, 12-09-2008 - 11:09am|
Vaccination debate: Parents' choice or public health threat?
By Kristi L. Nelson (Contact)
Sunday, December 7, 2008
When Laura Beeler's son, Zeke, 9, was a baby, she didn't think twice about having him immunized.
But when her daughter Leah Kate, now 5, was born, she gave vaccination a little more thought.
"I was more concerned when she was born because of all the media (coverage) and all the things I'd heard about autism" from friends, said Beeler, a Powell hair stylist. "I hadn't even heard of (those concerns) when Zeke was born."
Ultimately, Beeler had an in-depth conversation with her pediatrician, who was able to allay her fears.
She prayed about her decision.
And then she had Leah Kate immunized, although "we spread the shots out a little bit more so than we did with Zeke," she said.
Beeler isn't unusual. West Knoxville pediatrician Dr. Stephanie Shults said that as many as a quarter of the parents who come through her practice, Shults Pediatrics, have questions about vaccines.
Once the province of parents outside the medical mainstream, those questions are now being asked routinely. And there aren't any easy answers. While science has yet to find concrete evidence that vaccines damage children, the medical and pharmaceutical industries also have yet to win back the trust of wary parents.
Parents worry about a shot changing their child permanently, while public health professionals worry about the re-emergence of truly awful diseases that once killed or maimed huge numbers of children.
Pediatricians are caught in the middle, sympathetic to parents but strong in their own convictions that childhood immunization remains the best way to protect large numbers of the population from now-rare diseases.
Nationally, more than 80 percent of babies are still immunized. But even among them, how and when they get the shots are changing.
Set against shots
Melissa Cox decided before her children were born that she wouldn't vaccinate them. Cox, who lived in California at the time, visited a chiropractor while seeking relief from migraine headaches. The chiropractor was staunchly against vaccinations, and after giving Cox "a stack of research" that led her to do her own reading, she said, he had a convert.
Cox, of West Knoxville, now feels so strongly about her decision not to vaccinate Easton, 3, and Makenlee, 18 months, that she carries cards advocating for the Florida-based Vaccine Injury Coalition.
The cards list a bevy of unsavory ingredients in various vaccines - including formaldehyde, aluminum, lead, sulfates, yeast proteins, and tissues from chickens, monkeys, dogs, cows, pigs, rabbits, sheep and human fetuses - and urge, "Educate Before You Vaccinate."
"I think a lot of vaccines are unnecessary," Cox said. "I think there are too many - way too many."
Cox sees skipping them as one more way to keep her children healthy, along with keeping their diet "clean" and avoiding medications when possible.
She did worry, when Easton began preschool, whether his being unvaccinated would be a problem. Tennessee law requires proof of vaccination before a child can be enrolled in school; it allows parents a religious exemption, but not a philosophical one. Children can also have medical exemptions.
Cox believes vaccines go against her religious tenets, in part because some were made with human embryo stem-cell lines (derived before harvesting stem cells from embryos became illegal). But her nondenominational Christian church doesn't take a stand on vaccines. However, she learned that Tennessee requires only that parents sign a form from the health department; they no longer have to provide a letter from clergy.
Cox also worried about finding a pediatrician. More than one Knoxville practice openly refuses parents who don't vaccinate.
Cox's pediatrician, Dr. Michael Green of Trinity Medical Associates at Fort Sanders West, said he tries to address parents' concerns about vaccines, but he won't discharge their children if they decide not to vaccinate. Instead, he works on building a relationship of trust.
"My goal is that every patient I have that's a child be fully vaccinated," Green said. "I may have an altered view on approaching that, but I don't have an altered view on vaccination."
That's because he's seen just about all the diseases he vaccinates children against, with the exception of polio.
"When you see a child in the ICU with chicken pox, who has encephalitis or is about to lose an eye because of an infection, then you look at the parents and you think, 'Where's the vaccine?' " he said. "Almost 100 percent of the time, that would have prevented the worst-case scenarios. And you feel horrible. … You almost wonder, what will it take before people start to realize that we're not just playing around, these aren't just 'what color outfit am I going to dress my kid in?' These literally can be life-and-death decisions."
The re-emergence of almost vanquished diseases is a key argument for proponents of vaccination.
Earlier this year, the national Centers for Disease Control and Prevention reported 131 cases of measles, the most reported in more than a decade. They found 95 of those infected could have been vaccinated but weren't - 63 of them because of their parents' philosophical or religious beliefs. Only 17 people picked up the disease overseas; the rest were infected in the United States.
Public health officials argue that getting children vaccinated is for a greater good because it protects those who can't be vaccinated - young babies, people with immune-system problems and children undergoing chemotherapy, to name some - as well as the 5 percent to 15 percent of the population for whom the vaccines don't work.
"If most everybody is vaccinated, it's going to protect the weaker ones," Shults said.
Green admits to some frustration when a patient's entire appointment is spent discussing vaccines, leaving no time for other important topics. At the same time, he's not unsympathetic.
"There are times when people say, 'OK, I think I'm going to do it today,' and you feel for them, because you feel the anxiety that they're about to do something they are really unsure about," Green said. "You want to say, 'Gosh, I've done my own kids, we do tons of kids. This is not like sending your kid over Niagara Falls in a barrel. We do this all the time.'"
When she began practicing pediatrics 14 years ago, Shults said, "it was so easy. Basically we told people what they needed, and they got it. Somewhere along the line, the trust between the medical profession and the lay people has collapsed."
'You just kind of lose them'
Debate over a vaccine-autism connection is partly to blame.
Cox, who once worked in public schools with special-needs children, believes there is a link. Though Easton is not autistic, he has been diagnosed with speech delays and sensory issues. Cox believes that had he been vaccinated, Easton might now be autistic.
Science has failed to find a link between vaccination and autism definitive enough to convince doctors and the government. The question divides even parents of autistic children.
Maryville mother Shaina Cutler believes her son, Brant, 9, had a genetic predisposition to autism, and that heavy metals, such as aluminum and mercury, in vaccines he got when he was between 18 and 24 months of age taxed his immune system to the point of permanent damage.
Cutler said Brant was a bright and bubbly baby, but that with each shot, he ran a high fever and was "glassy-eyed and lethargic" for days. By the time he was 2, she said, no trace of the happy, alert baby remained.
"You just kind of lose them," she said. "They're more distant. They don't look at you. They don't hear."
Had she made a connection between Brant's withdrawal and the shots earlier, she said, she would have stopped them. But Cutler had never heard of autism before her son was diagnosed. She now believes her daughter's onset of attention-deficit disorder also might have been hastened by vaccines.
Yet Cutler is on the board of the East Tennessee chapter of the Autism Society of America, which holds the position that there is no evidence of a link.
"I don't suggest that anyone not vaccinate their children," she said. "You don't want rampant disease … because everyone got scared and didn't vaccinate. I do have the opinion that they need to spread out the vaccinations."
If Cutler had a younger child, she would space out the shots, or perhaps wait until the child was 4 or 5 years old to start them, she said.
Many parents are finding such a "delayed schedule" to be a compromise between wanting the protection of vaccination and fearing the vaccines.
Taking more time
Jessi Blessinger of Farragut follows a modified version of Dr. Robert Sears' suggested "delayed schedule," never getting more than one shot per visit for her 15-month-old son, Leo.
Blessinger's husband, a physicist, travels overseas to Asia, South America and Central America frequently. Blessinger, though she has reservations, sees vaccination as the best way to protect her son from some diseases that his father, who has been vaccinated, might be exposed to. So she read about each vaccine and its purpose, choosing the ones that were "nonnegotiable," including pneumococcal and Hib (Haemophilus influenzae type b), which she felt strongly enough about that she took Leo to the health department to get it because a shortage left his pediatrician without it.
Some other shots she decided to skip, including the vaccines for rotovirus ("still too new") and chicken pox (she worries that immunity would wear off when Leo is older and set him up for a more severe case than he would have had as a child).
"At the end of the day, everybody's going to do what works for their family. At least if you know people are putting thought into the decision … then you know that a good decision was made for that family," Blessinger said. "I'm probably never going to be 100 percent sold (on) either (position), but for now, this is what works for us."
Blessinger's pediatrician, Dr. Mark McColl of Trinity Medical, agreed to follow the Sears schedule because, he said, late vaccination is better than no vaccination. But he thinks the worry that too many vaccinations at once might "overload" a young child's system are unfounded.
"A child can come in and get six shots - at most, three needles worth of stuff," he said. "The likelihood of being exposed to 10 times that amount of stuff going to Walmart is a guarantee. You sit in my waiting room, you're going to be exposed to more things than I'm going to give you in that needle."
Parents sometimes balk at the newer "combo" shots, which have several vaccinations in one needle. Doctors like the combo shots for two reasons, Shults said: First, the child is injected fewer times, and second, it's easier to get the shots done early, and thus better protect the child.
It is possible, but not usually practical, to give individual vaccines instead of combo shots. For example, though drug company Merck, which makes an MMR combo shot, still makes individual vaccines for measles, mumps and rubella, they have to be ordered in bulk. Most doctors don't have enough requests to justify the cost, and insurance won't always pay for the individual shots.
They're not always easy to find, either. Though a Merck customer service representative said the company hasn't discontinued the individual vaccines, none is currently available.
The newer vaccines are often better, Shults said. Polio and DTap are two; older versions of both more often caused adverse reactions.
"When I first came out of residency, we'd call back everybody (whose child had a shot) the next day and make sure they were OK," she said. "We don't have to do that anymore. They may run a little fever, and they may be a little fussy, but for the most part, 90 percent of the kids are going to tolerate them very well."
McColl, Green and Shults all say they've reviewed anti-vaccine information parents have brought them. They also keep up-to-date on studies from sources they trust. Nothing they've seen so far sways their conviction that the risk of vaccination is smaller than the risk of not vaccinating.
Vaccines "changed the way I do medicine," Shults said. "Take (pneumococcal): When we had a kid with a 104-degree fever, we told you to go to the ER. You couldn't leave that kid sitting at home with strep pneumo - they could be dead the next morning. A perfectly healthy kid.
"We don't do near as many blood cultures, inject as many antibiotics, or have as many ER visits. Then the rotovirus - oh, my goodness. In my practice alone, we used to send five or six kids to the hospital each year with rotovirus. Last year, I didn't have one."