Shots in the Dark
Emanuela Gay hasn’t had her 3 1/2-year-old daughter inoculated against childhood diseases because she doesn’t believe vaccines work well enough--or are safe enough. The Mill Valley, Calif., mother allowed Maddalena to develop immunity to chickenpox and measles the old-fashioned way--by getting the illnesses.
Other parents, stirred by reports of lasting damage from vaccine reactions, immunize selectively against those infectious diseases they believe pose a threat to their children.
A growing number of moms and dads are questioning the common wisdom.
Years ago, parents dutifully followed their pediatrician’s recommended schedule of childhood vaccinations. The value seemed unquestionable after devastating polio outbreaks left thousands entombed in iron lungs.
At one time, polio shots were the only immunizations.
Today, children commonly return home from the pediatrician’s office with cartoon-character Band-Aids on their arms: A fully immunized child receives 19 vaccinations by age 5. Public health officials are poised to expand the list.
In the meantime, concerned parents are going public with contentions that their kids’ autism, hyperactivity, seizures and other illnesses stemmed from the inoculations. They also claim that vaccines may be driving a rise in chronic conditions like asthma and arthritis.
Rep. Dan Burton, R-Ind., has added his voice to the fray in hearings he convened as chairman of the House Reform and Oversight Committee, which oversees federal health agencies. His 5-year-old granddaughter was hospitalized hours after receiving the hepatitis B vaccine, and his 2-year-old grandson developed autism after a pertussis vaccination.
“You can call that a coincidence, but I think it is more than coincidence,” Burton said at an August hearing.
Medical experts fear such anecdotes scare parents without scientific proof.
“Vaccines are among the 20th century’s most successful and cost-effective public health tools for preventing disease, disability and death,” Surgeon General David Satcher told Burton’s committee. “While vaccines are among the safest pharmacologic interventions available, no drug or vaccine is 100% safe without risk.”
Established Guidelines
Called Into Question
A new breed of activist parents refuses to take doctors’ and government recommendations as gospel. Although vaccinations are required for school enrollment, some mothers and fathers are exercising rights to exempt their children. Currently, all states allow exemptions for medical reasons, 48 for religious beliefs and 15--including California--for philosophical beliefs.
Gay, who got an exemption for Maddalena to enter preschool, isn’t blind to disease dangers but believes vaccinations administered as early as minutes after birth are “an assault on the immune system at an age that is very premature.”
When others criticize her decision not to inoculate her daughter, she responds: “I choose based on information I have gathered myself.”
Many parents question giving hepatitis B vaccines to newborns because the blood-borne liver disease is primarily transmitted through intravenous drug use or sex. Health officials, however, argue that children should be vaccinated early for protection against transmission through unknown routes. Also, they say it’s harder to get older children in for immunizations.
Abigail Disney of New York City believes in vaccines but is grappling with whether to let her son, Henry, 3 1/2, get the relatively new chickenpox vaccine. Her two daughters got through the itchy illness just fine. The chance of complications like skin infections with streptococcus A doesn’t “outweigh the anxiety I have about a new vaccine, the long-term effectiveness of which hasn’t been proven to me convincingly and the long-term consequences of which haven’t been explored,” she says.
Public Health Officials Fear Return of Diseases
Skipping some vaccinations troubles public health officials, who depend on high compliance to create a protective shield around the population.
While inoculations have reached record levels of 90% for some vaccines, experts fear that not vaccinating could allow dangerous diseases to reemerge.
Available figures don’t show an upsurge in Californians opting out of vaccinations, says Dr. Natalie Smith, immunization branch chief of the California Department of Health Services.
Many Americans have either forgotten or never lived through the periods when children used to die from outbreaks of diseases such as measles or polio. Some of these episodes weren’t so long ago. A regional epidemic of measles in Los Angeles that peaked in 1990 resulted in a reported 4,549 cases and 12 deaths, notes Dr. Walter Orenstein, director of the Centers for Disease Control and Prevention’s National Immunization Program.
From 1958 to 1962, before measles vaccinations, the nation posted more than 500,000 annual cases. Last year, there were 89.
More than 16,000 cases of polio and nearly 1,900 deaths occurred annually from 1951 to 1954, before introduction of a vaccine. By 1991, polio was driven from the Western Hemisphere.
Similarly, before the German measles vaccination, 20,000 infants suffered from birth defects like deafness, blindness and retardation in a 1964-65 epidemic because their mothers became infected during pregnancy. With widespread rubella vaccination, there’s barely a threat to babies.
Orenstein supports more research to clarify the risks and benefits of vaccine programs.
That’s what Barbara Loe Fisher, founder of the National Vaccine Immunization Center in Vienna, Va., seeks. She co-founded the advocacy organization after her oldest son developed multiple learning disabilities she links to an adverse pertussis-vaccine reaction.
Most parents, Fisher says, want “the truth about the risks and complications.” But without basic research, “we’re never going to be able to separate out those health problems connected to vaccines and those which are not.”
She lobbied for the FDA to license a safer, purified version of the pertussis vaccine to replace the whole-cell version, which sometimes causes serious side effects like brain inflammation and brain damage. But she bemoans that the riskier, whole-cell version remains on the market.
When asked why it’s still available, Orenstein says the rate of brain problems remains “very rare”--up to 10 per million. “Our advisory committees have never considered whole-cell vaccine unsafe. They consider acellular safer.” He says whole-cell pertussis is primarily used in a combination vaccine that immunizes children against several illnesses in one shot, a convenience for parents and kids.
Government is making inroads toward safer vaccines. By Jan. 1, oral polio vaccine, which contains a weakened polio virus that infects some children each year, will be completely replaced with the pricier killed-virus vaccine, which can’t infect. Federal agencies pulled from the market a vaccine against diarrhea-producing rotavirus after some babies developed intestinal obstructions. Vaccine manufacturers have been asked to reformulate vaccines without the mercury-containing preservative thimerosal because mercury can damage the brain.
The CDC is conducting or sponsoring studies into whether vaccines are a factor in development of autism, diabetes, brain illnesses and asthma.
No Evidence for Austism Concerns
For now, doctors are sympathetic to heartbreaking anecdotal reports but see no solid evidence that, for example, measles vaccine causes autism.
“The evidence that it’s causative has been very questionable,” says Dr. Isabelle Rapin, a child neurologist and autism expert at Albert Einstein Medical Center in the Bronx, N.Y., who sees only coincidence. Rapin frets that decisions to forgo the measles vaccination could prove tragic. Parents don’t realize that one in 1,000 children who come down with measles develop measles encephalitis, a disorder that can destroy the brain and is “much worse than autism,” she said.
Dr. Sidney Gospe, a neurology and pediatrics professor at UC Davis, takes the middle view: “One has to be cautious about saying no, there can’t be a relationship and saying yes, there must be a relationship” between vaccines and autism. “I’ll give the parents the benefit of the doubt and say this is something that needs to be considered.”
Activists and attorneys who represent neurologically impaired children hurt by the pertussis vaccine urge better education of parents and doctors in understanding vaccine precautions and reactions.
David E. Lewis, a Santa Monica attorney who has handled pertussis claims for plaintiffs, complains that doctors “don’t know to tell somebody to hold off having the vaccine if the child has any illness--even a serious cold.”
A San Gabriel Valley mother who asked only to be identified as Suzanne says her daughter, Jaclyn, was immunized for pertussis while suffering from her first cold. Although she specifically asked the doctor if it was a good idea to vaccinate that day, he assured her it was no problem. The 6-month-old child immediately began several hours of high-pitched screaming, now recognized as a bad reaction to pertussis vaccine, and slipped into a coma. She emerged with severe brain damage that might have been avoided had the doctor followed the manufacturer’s caution against vaccinating a sick child, Suzanne says.
Dr. John Menkes, director emeritus of pediatric neurology at Cedars-Sinai Medical Center, compares overall vaccine risks to the risks of flying.
“You’re exposed to being in a crash, [but] we all take the plane,” says Menkes, who has testified in pertussis cases. No one knows the cumulative impact of giving 19 vaccines in early childhood, and “if they claim they know, they are lying.”
All of which makes him sympathetic to vaccine injuries: “If the incidence is one in 100,000 and you’re the one, it’s 100%.”
For more information, the National Vaccine Information Council’s Web site is at https://www.909shot.com or by calling (800) 909-SHOT. The Centers for Disease Control and Prevention has a toll-free immunization hotline at (800) 232-2522 and a related Web site https://www.cdc.gov/nip. The American Academy of Pediatrics has vaccine information on its Web site at https://www.aap.org.
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Vaccines for Adults
* Flu immunizations and other shots are recommended for adults, especially the elderly. S8
