Vaccinate on Time

A reporter from Myrtle Beach reached out to me today to ask me about my response to a vaccination issue that had been raised by a parent from his area. I am the Immunization Liaison for the SC Chapter of the American Academy of Pediatrics, a staunch advocate for vaccines, and someone had pointed him in my direction.

Apparently a father had taken his two month old for a well check and was told that if the family didn’t give the child six vaccines (which I assume are the routine recommended ones against tetanus, diphtheria, whooping cough, polio, Hepatitis B, 13 strains of pneumococcus, haemophilus influenza, and rotavirus), he would need to find a new practice. Was that fair?

“Yes,” I replied. “Yes it is. Our office has come to the same decision after years of meetings and discussions and ethical deliberations. We along with many other practices have also decided not to see children whose parents choose not to vaccinate on the recommended schedule. We will see them to discuss the immunization schedule and answer questions, but unless there is a medical reason not to immunize the child, we don’t feel it is safe or fair to expose other families in our practice to those who choose not to help protect  children from preventable illnesses.”

Then I tried to explain what has lead us all, people who have studied for years to care and advocate for all children and families, to a decision to exclude some families from our practices.

I appreciate when parents ask questions and advocate for their children. I really do. I am a skeptic at heart, an advocate like them. I am a parent too. Our children depend on us to ask tough questions and make hard decisions.

They also depend on us to listen to the answers and make the right decisions based on risk assessment, facts, and science.

But increasingly over the years, we have seen parents who are not interested in our recommendations or the information we provide about required and recommended vaccines. They have “done their research” on facebook, referencing a Russian bott post or a nebulous blog or their chiropractor’s concern about the aluminum that is used to enhance the effectiveness of the vaccine (breast milk has more aluminum than vaccines do).

It doesn’t matter what the science says or how much their decisions are opening other families to harm. They have made up their minds not to vaccinate or to vaccinate on a schedule that leaves the child vulnerable to diseases at the time when they most need protection. Breaking up vaccines and prolonging the time it takes to complete the schedule is simply not a good idea.

I am not sure what the reporter will include in his article, but since I’ve been storing up my frustration about this topic for quite some time now, here are some of the highlights that I hope he will include:

  1. Pediatricians across our state have watched with despair as parents increasingly choose to delay or opt out (of vaccinating their children. We see vaccines as the single most important, most miraculous, and most amazing scientific discovery ever, one that has allowed parents to send their children out to play or go to the swimming pool each summer and not worry that the fever they might spike a few days later will be the first signs of polio in their child.
  2. When I was in training in the early 90’s, I was really good at doing spinal taps in little babies because we did them all the time. If an infant came in with a fever and there was no obvious ear infection and he was extremely irritable, a likely cause was H Flu (haemophilus influenza) meningitis. Despite early diagnosis and aggressive treatment, many of these infants went home with hydrocephalus and brain shunts which would then malfunction or get infected off and on for the rest of their shortened lives. They were discharged with early signs of cerebral palsy. They went home with lifelong hearing loss and cognitive disabilities. All that changed in the mid 90’s, though, because by then, all infants had gotten the new H Flu vaccine. Rates of bacterial meningitis plummeted, as did other life threatening infections associated with H flu, and along with it, so did the complications. I don’t miss doing spinal taps on adorable screaming infants whose moms are looking on, terrified from the corner of the room.
  3. In the late 90’s we still routinely saw infants and toddlers with high fevers and blood infections due to several types of pneumococcal bacteria. We routinely did blood work to determine whether a child with fever and no other symptoms might have “bacteremia”–a blood infection that could deposit that nasty bacteria in the baby’s brain, lungs, bones, or ears. But then a vaccine to protect children from many strains of this bacteria burst onto the scene (Prevnar which protects from 13 strains of pneumococcal bacteria), and we rarely see serious complications of pneumococcal infection anymore.
  4. The reporter asked me about religious exemptions. I told him I am not aware of any religions which recommend that their followers put their communities at risk for preventable illnesses, yet in one daycare in a faith community near us, I am aware that 24% of the children are unvaccinated. Vaccines don’t always work perfectly in each individual, but if enough people are vaccinated, an entire community and the individuals within it are much less likely to succumb to an epidemic.
  5. Measles was declared eliminated from the United States in the year 2000.  We now have over 700 cases and counting in 2019, and the year is young. The reporter said
    “but we haven’t had any cases in South Carolina, right?” Not so far in 2019, but there were 6 cases in Spartanburg, SC last fall. The case in Georgetown, SC in 2017 was the first case in SC in 21 years. We can expect those numbers to rise quickly if parents continue to choose not to protect their children and their communities from easily preventable illnesses.
  6. The safety of vaccines is monitored closely. I am old enough to remember the old DTP vaccine which was replaced by a new DTaP (acellular pertussis vaccine) due to an increased risk of seizures with the old vaccine. I remember when rotavirus vaccine was taken off the market soon after its introduction due to concerns of intestinal complications, then reintroduced. I recall giving oral polio vaccine because it was more effective than the shot… until the risk of transmitting attenuated polio virus through the vaccine became greater than the risk of getting wild type polio, so we all switched to giving the killed vaccine. Safety is always the most important consideration when we are administering anything at all to a healthy child.
  7. I don’t miss admitting toddler after toddler with dehydration due to rotavirus. One of the last ones I recall admitting was a 20 month old who had had 40 stool filled diapers well before noon. When she got to the hospital, her mother later told me that her eyes were hollow and her lips were so dry they were curling back and sticking to her gums. “I was so scared,” she told me. Rightly so. In countries where children don’t have easy access to Rotavirus vaccine, they still die routinely from dehydration due to this virus.
  8. I remember the epidemic of pertussis (whooping cough) several years ago in a group of homeschooled children who had not been vaccinated in our area. After observing firsthand how horrible the “100 Day” cough was, many in the group came to our office requesting that their children be vaccinated. I also remember the baby who was counting on our community and those around him to be vaccinated against whooping cough, but his community let him down, and he died of pertussis in the hospital. There is no effective treatment unless it is suspected in the first few days, when it looks like any other routine cold. (Family members should all get a Tdap booster to welcome and new infant into the fold).
  9. There are risks of vaccines, but they are much smaller than the risks of failing to get vaccinated on schedule and getting the disease.
  10. Vaccines do not cause autism. Study after study confirms this. Period.

We appreciate parents who question and advocate and ultimately make the safest decision for their children and their children’s community: vaccinating on time.

Taking a strong stance on vaccinating children according to the evidence-based recommended schedule is one of the most important things pediatric practices can do to protect the lives and health of our nation’s children.

Martha Edwards, MD