• Delaying vaccinations is stupid

    Kristen Feemster and Paul Offit were less confrontational, but I’m tired of this crap. “Delaying Vaccination Is Not a Safer Choice“:

    According to a recent study of surveillance data from the Vaccine Safety Datalink published in this journal, 48.7% of children were undervaccinated at some time prior to their second birthday and 1 in 8 were undervaccinated owing to parental choice to delay or refuse certain vaccines. Undervaccination has been attributed to access to health care services and missed opportunities. Now, however, it has become increasingly evident that it is the result of vaccine hesitancy as parents question the need for certain vaccines and request alternate schedules.

    A growing number of studies have investigated the predictors of requests for alternative vaccination schedules. These studies show that the decision to delay or refuse certain vaccines among parents is associated with beliefs regarding vaccine safety, efficacy, and perceived risk. While this choice may be largely grounded in parents’ desire to make the safest choice for their child, there are many reasons why delaying vaccines offers no clear benefit and puts children at unnecessary risk. The most significant consequence is increasing the amount of time an infant or young child is susceptible to a vaccine-preventable disease, often during the time when a child is most at risk for severe infection.

    Vaccines are safe. They’re studied before they are released, and they are followed more closely than pretty much any other drugs. Gazillions of kids get them. They’re monitored. The Institute of Medicine recently released a report that reviewed all the data and concluded they didn’t increase the risk of “autoimmune diseases, asthma, seizures, developmental disorders, hypersensitivity, or attention-deficit disorders.” the current schedule is optimized to achieve a good immune response, achieve protection before a child might be exposed, and prevent adverse events. We didn’t pull it out of a hat.

    Some parents delay vaccines because they think there are too many shots given at a time. That misses the point. From our second book:

    Let’s start by recognizing that the human body has an enormous capacity to respond to potential threats.  You are constantly exposed to foreign substances that stimulate your immune system.  In a manuscript specifically designed to answer this question in the journal Pediatrics, Dr. Paul Offit and colleagues estimated that infants likely have the capacity to respond to about 10,000 vaccines at any one time.  No vaccine could “use up” the immune system.  In fact, estimates showed that if a child received 11 vaccines at one time, that might occupy about 0.1% of the immune system.  You’d never notice that.

    Moreover, this argument assumes that the cells being occupied or destroyed in the vaccine response process are not replaced.  You body is constantly making new cells, though, so this never occurs.

    Another point, often overlooked, is that it is not the number of vaccines, or even shots, that matters.  It’s the number of antigens in those vaccines.  Advances in technology have allowed for fewer and fewer antigens to be required to achieve a good response.  So while a single smallpox vaccine hack in the day had over 200 different proteins in it, and the 7 vaccines in the 1980’s contained more than 2000, the 11 vaccines in the currently recommended schedule have only about 125 in all.

    Don’t take our word for it.  Research has shown that giving vaccines alone or in combinations does not affect their ability to achieve a response.  A trial comparing the effectiveness of the MMR and chicken pox vaccine given together and alone showed no differences in their effectiveness.  Another study comparing simultaneous administration of the MMR with DTP and polio boosters to sequential administration of the individual vaccines to be equivalent.  The same was seen when looking at adding Hepatitis B vaccines to others in infants.  Your body can easily handle the load.

    In a final slam, this editorial noted that while some parents choose to delay vaccines because they think it will prevent overload, doing so increases the risk of adverse events (emphasis mine):

    In this case, the results suggest that delaying administration of measles-containing vaccines increases the risk of fever and seizures, the majority of which were febrile seizures.

    So delaying vaccines not only leaves your children and other children at risk for preventable illnesses, it also increases the risk of fever and seizures. Don’t do it.


    • Aaron: Thank you for this detailed well written, strongly worded, clear, message to those who in the name of protecting their children are in fact harming. Bravo

    • This is evidence-based science. Accepting your conclusions requires acceptance of science. Unfortunately, it seems as if this is less and less likely as time goes on. Very sad.

    • Dr. Carroll you are the pediatrician. I treat those going through their second childhood. I am not looking for a debate rather a clarification so that I can better understand what is occurring with childhood vaccinations on a physician level.

      I so happen to believe that vaccination is good. I am more concerned about the timing quantity and press statements. I wonder if some of the timing has to do with PC rather than good medical care. The hepatitis vaccine is one that comes to mind. I worry about the use of so many vaccines so quickly even though we do not see reports of increased auto immune diseases. Time not infrequently corrects many of our mistaken impressions and the use of vaccines seems to be spiraling. I also worry about how the studies on safety and efficacy are being performed (I haven’t studied it in your field, but I have in mine and have been burned numerous times.). Your comment about fewer antigens is reassuring to some degree, but not reassuring enough for the quantity, timing and press releases of the vaccinations.

      I so happen to have spoken to some of the physicians that were involved in the approval of the first oral diabetic agents decades ago. They had specific fears that were born out many years later. I want to hear your thoughts.

    • Dr Carroll is correct that vaccines are safe/effective for MOST children.

      However, he blithely waves his hand as if it is safe for everyone, when in fact, it is not.

      Take the case of Hannah Poling. Her father is a pediatric neurologist at Johns Hopkins. She received vaccines and quickly developed severe developmental disabilities (I wont call it autism, but it is classified as a pervasive developmental disorder).

      Now, Dr Carroll’s response is that Hannah would have gotten this disorder regardless of vaccines. But that is not true. It turns out that Hannah has an underlying mitochondrial disorder. The mitochondrial disorder by itself doesnt caues any neurological problems. However, certain adjuvants/preservatives used in vaccines cause the mitochondria to build up toxic metabolites, and these toxic metabolites trigger neurological problems.

      This is why the vaccine court admitted that vaccines contributed to Hannah’s condition and granted her family a financial settlement.

      Dr Carroll is right to suggest that the vast majority of kids will do just fine with vaccines. He is wrong to give them to EVERYONE regardless of medical history, and I’m not just talking about allergies to eggs or other known contraindications to vaccines.

      • This kind of thinking is exactly why parents decide not to vaccinate their children. The medical establishment’s response is generally vaccines are the right choice 99.99% of the time, here’s the proof, but don’t address the concerns (valid or not) of the parents who think their children are in the .01%

        I had this issue at the height of the Autism-MMR scare in England. My son has relatives with Autism and that was my biggest fear, even before I heard about the whole vaccine thing. Yet, there was no literature that helped me conclude that the right choice for HIM was the vaccine. I had a friend whose niece had had febrile convulsions with the DTP, so she didn’t give her kids DTP and her son got Whooping cough. Again, her doctor didn’t address her concerns.

        I won’t argue that these concerns were valid, but they were worried (and well-educated) parents who researched the issues,( but did that research without access to medical or university libraries) and the concerns weren’t addressed.

    • It is funny that vaccinations the most effective of health care are attacked by some even as they demand questionable care.

      • Floccina, I agree that vaccinations are one of the most effective elements of health care. However, in recent years we have seen more and more vaccinations for lesser and lesser problems. Is this good or bad? I assume it is good, but really don’t know. Thus when a parent asks me as an Internist what to do I have no choice but to refer them back to the pediatrician. To get more than a superficial answer one has to look deep and understand a multitude of variables. Do the pediatricians have a deep and broad understanding of our vaccination policies? I don’t know.

        I wonder if the shear numbers of vaccinations and the timing is not responsible for some of the reluctance some parents have to vaccination. In earlier times the risk from vaccination was much greater, but so was the reward (think of polio). Has that relationship changed so that one might have second thoughts? On a statistical level I don’t think so. On an individual level I am not sure. I don’t feel comfortable as a physician that I am adequately informed of all the reasons for the protocols we have today.

        Example: Hepatitis B

        How prevalent was B before vaccinating the infant leaving the hospital? Was the perceived problem prevalent in all groups and if not prevalent in the mother’s group was it necessary at that time? Was PC involved? Was starting the shots in the hospital nothing more than the easiest solution?

        Even if all the answers were against giving the vaccine I might still be in favor of the current regimen from a public health perspective even though the public health perspective might not pertain to individuals.

        There are serious reactions that can occur with all vaccines (though rare) and vaccines do not necessarily offer the desired protection. One always has to remember history so one should think of the swine flu decades ago and how poorly that was conceived and managed. Sometimes we think we know more than we do and try and convince the public of things we aren’t sure of ourselves. Long term that is a bad idea.

        • ‘However, in recent years we have seen more and more vaccinations for lesser and lesser problems.”

          So more vaccinations correlate with lesser problems?

          Seems to me that the obvious conclusion is that vaccines work.

          • Yes, vaccines work and yes the problems the earlier vaccines treated were greater. Think Smallpox that nearly wiped out the native Indians in the western hemisphere.

    • Emily, vaccinations are among the most studied, well understood medical interventions (and along with sanitation, the most successful public health measures ever implemented. Remember small pox and polio? Neither do I. That’s the point.)

      If you question vaccines, I wonder how you prescribe any medical interventions to your patients?

      • Sheldon, apparently you didn’t focus enough on what I said. I was mostly concerned with the timing and the number of vaccines given over a short time period.

        I well know the benefits of vaccination, but I also study the complications along with what happens with the overuse of any medical treatment. Do you remember the swine flu vaccine of 1976? I do. Remember the many cases of Guillain-Barre? I do and I was one of those that helped organize and provide the vaccine to tens of thousands of people in my community during the drive to vaccinate everyone in a few days. All this was volunteer work that perhaps should never have been done because the flu never progressed, but a good number of those that became ill were very ill.

        Therefore, I think one should not deal with generalizations as you are doing.

        As far as how I prescribe medications… very carefully, for frequently we can do more harm than good. I treated a predominantly critically ill and chronically ill population so your swipe at my abilities can only represent your naiveté.

        • Emily, I did not intend to swipe at your abilities at all . I agree with everything you say about overuse and possible harm caused by medications and other health care interventions. But, whether you intended it or not, your previous comment is easily interpreted as questioning not only the timing and number of vaccines, but the need for them and their effectiveness (especially given the detail in Aaron’s post about dose, number, and sequence of vaccines).

          So, again, let’s stick to evidence. That’s what Aaron presented. There is enough unnecessary vaccine hysteria out there already. Health professionals SHOULD question conventional wisdom. But with science and evidence, not feelings.

          • “your previous comment is easily interpreted as questioning not only the timing and number of vaccines, but the need for them and their effectiveness ”

            This comment of yours is pretty lame especially considering my opinions on the subject in the two prior postings where I even said that I would probably agree with the present public health initiative regarding vaccination no matter what the answers to my questions were. If it isn’t a lame attempt to resurrect yourself then you are more naive than I previously thought. Even your last point “But with science and evidence, not feelings.” demonstrates that you have strayed far from what anyone else has said. Recall that my initial statement was an inquiry where I first stated that “I so happen to believe that vaccination is good.”

            Of course you might still choose to argue these points, but then you are forced to quote my comments *in context* and defend your position. I believe you will fail, but I will fairly listen to your argument. Good luck.

            • Emily, I’ve been called many things, but rarely naive. Ad hominem attacks really aren’t necessary. If you have science/facts to back up your concern about the frequency of vaccines, despite Aaron’s original post, please share them.

            • Sheldon, I think the term naive is quite accurate. You certainly haven’t demonstrated anything less than naiveté nor have not been able to quote in context any of my comments that led to your misstatement of what I have said.

              You said: “your previous comment is easily interpreted as questioning not only the timing and number of vaccines, but **the need for them and their effectiveness**”

              How foolish that statement sounds when I have already clearly stated that I believe they are beneficial adding that I was in favor of their use.

              “I so happen to believe that vaccination is good.”

    • I would still provide the flu vaccine to vulnerable groups
      and those that desire it even after reviewing this article, but it
      is worth reading. The article gains credibility by being published
      in the BMJ. http://www.bmj.com/content/346/bmj.f3037 “The CDC
      pledges “To base all public health decisions on the highest quality
      scientific data, openly and objectively derived.” But Peter Doshi
      argues that in the case of influenza vaccinations and their
      marketing, this is not so” … “Closer examination of influenza
      vaccine policies shows that although proponents employ the rhetoric
      of science, the studies underlying the policy are often of low
      quality, and do not substantiate officials’ claims. The vaccine
      might be less beneficial and less safe than has been claimed, and
      the threat of influenza appears overstated.” The article was
      published May 2013 Much of what Doshi says is not controversial and
      demonstrates that things are not as simple as some believe. For
      some other opinions look at the letters to the editor, but take
      note that there are many issues to deal with and medical science is
      limited in that direct double blind experimentation in humans has a
      lot of ethical issues attached.