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Childhood Vaccinations – Safe and Healthy

March 25th, 2011 by avatar

[Editor's Note:  Recently, Science & Sensibility reader and childbirth educator, Lucy Juedes, wrote in hoping to see a blog post on the topic of childhood vaccinations.  After very little arm twisting, Lucy was coerced excited to compile the following post, complete with guidance as to how she approaches this topic, while teaching classes.]

 

Introduction
My community, perhaps like yours, seems to have a growing number of parents who don’t vaccinate their kids.  These diseases, such as highly contagious pertussis (whooping cough) and measles, are showing up in more and more outbreaks, affecting more and more of our families.

As Lamaze Certified Childbirth Educators, we are in an excellent position to share the strong evidence supporting childhood immunization, while listening to and addressing parents’ concerns in an open, caring setting.

 

Evidence-Based Vaccine Information
From a parental perspective, the primary issue to address regarding vaccines is safety.  And, from an evidence perspective, the overwhelming majority of immunology and public health experts have found the currently recommended vaccines to be safe for the overwhelming majority of children.  Vaccines are tested on more people for longer durations than any other drugs.  Innovations have decreased the number and scope of side-effects.  And there is a full-circle program to promptly notify governmental health experts of any rare adverse events.  (Offit)  It would be nice if there was this much expert consensus about the use of common interventions in childbirth, such as continuous electronic fetal monitoring or denying food to a laboring woman!

And, whether we look at the Centers for Disease Control and Prevention, the World Health Organization, medical organizations such as the American Academy of Pediatricians or The American Academy of Family Physicians, leading medical facilities such as the Mayo Clinic, or established organizations like The March of Dimes, they all have the same message:  vaccination against preventable childhood diseases is safer and healthier than not vaccinating.  We only need to examine history to see the alternative to not vaccinating:  natural selection.  (Diamond)

 

Vaccination Talk
A little context first.  By the time I share the vaccine information, the moms and partners are pretty steeped in three key ideas:  evidence-based decision making, the parents as the best decision-makers for their families, and that mirroring each others’ decisions isn’t necessary.  Most of the moms and partners talk a lot in class (Any question, any time!), so I’ve had ample opportunities to share how they can use these ideas in the wide range of decisions they’ll make about their own and their child’s care.  These key ideas help parents to hear the very strong evidence-based nature of vaccinations as well as that they are the best people to decide what to do, and that they can decide differently than their friends and remain good friends.

So, what do I do in my class?  I share that vaccinations do a great job of preventing childhood diseases—the best we’ve come up with so far.  Vaccinations are safe for just about everyone and will keep their baby healthier than not vaccinating.  I suggest that their doctor or nurse will ask specific questions to prevent an allergic reaction, such as if the child is allergic to eggs (some vaccine viruses are grown in chicken eggs).  And I share the above information about the evidence-based foundation supporting vaccinating according to the suggested CDC/AAP/AAFP schedule.

This discussion takes about five minutes, and I hand out the list of childhood diseases and vaccines that prevent them and the suggested time line, downloaded from the CDC’s web site.  I also offer the web sites of the above listed organizations should folks want more information.



 

Specific Questions from Participants
Inviting participants to share details of what they’ve heard or read is a great way to encourage class dialog about this topic.  My goal here is to discover concerns, as well as common myths or misgivings about vaccination, and to address these simply and quickly.  Here are the three most often asked questions and my responses.

 

I’ve heard that vaccines have mercury in them and that they cause autism.”

 

“Vaccines contain very little mercury, and they don’t cause autism.  About autism, there’s absolutely no evidence of a link between vaccines and autism.  It’s understandable that a parent might think there is because autistic characteristics are often noticed around 18 months, and by that time, at least one part of all the suggested vaccines have been given.  But specialists in the academic and public health areas have studied this up and down and have found no link.  And not just doctors, but specialists in immunology and child health. (Offit)  Actually, the closest researchers have come to finding a cause for autism are recently discovered rare, very unique genetic variations in children with autism. (Shute)

“You also mentioned mercury.  The active ingredients in vaccines need to be preserved in order to stay effective.  Some vaccines, like the Measles, Mumps, and Rubella vaccine that was used before 2001, use thimerosal as this preservative, and thimerosal has mercury in it.  However, since 2001 thimerosal has been taken out of all vaccines recommended for young infants.  But autism has increased, not decreased.” (Offit)

 

“We’re thinking about doing an alternative schedule — it seems like there are so many vaccines given to a baby.  Too many for their little bodies to handle.”

 

“Actually your baby is exposed to many, many more microbes, bacteria, and viruses every day—many more than are in vaccines.  And a single infection of the common cold causes a much stronger reaction in a baby than if we were to give all the suggested vaccines at one  time to him or her.  The science behind vaccines has been refined a lot in the century+ that we’ve been making them. Now, there are very few ingredients in them—even with the grouping of vaccines into one shot like in the MMR and DTaP.  And nothing else will help their little bodies develop strong defenses against these diseases than the associated vaccines. The sooner babies are immunized, the sooner they’ll become more protected.”  (Offit)

 

“I’m worried about our baby being allergic to something in the vaccine, and if we give several vaccines to our baby at the same time, how will we know which one caused it?”

“On its web site, the CDC has a thorough list, likelihood, and timing of all vaccine allergic reactions or side effects.  As you look at each new round of suggested immunizations, it could be that the vaccines’ possible side effects don’t overlap, so it would be clear which vaccine caused a reaction.  Or, if side effects were similar, most reactions usually show up a few hours to a few days later, so you could space the shots a few days apart.  And the side effects are generally nothing that a little TLC and maybe a fever or pain reducer won’t take care of.  And I want to stress that even the mild side effects are uncommon and the difficult side effects are rare, or why would our health experts recommend the vaccines?

“Be ready to comfort your baby after the shots while still in the Dr.’s office, especially with breastfeeding.  And I don’t tell my baby not to cry; that’s how they communicate with us.  Often babies are fine a few minutes after.”

 

Our overall vaccination discussion generally takes about 10 minutes.  By the end of it, the moms and partners know the strength of the evidence supporting vaccinating.  They also have more information to use in discussions with each other, family members and friends, and to supplement their search for information.

 

Other Class Discussions Related to Vaccination
Vaccination discussions don’t only come during the specific talk at the end of class.  At the beginning of class when we talk about staying healthy while pregnant, I talk about the protection that the current seasonal and H1N1 flu vaccination gives pregnant women.

When we talk about choosing the baby’s doctor, we talk about finding a caregiver with a similar approach to health as they have.  I also note that as many as 4 in 10 practitioners won’t see non-vaccinating families. (Offit)  Also, if a parent decides not to follow the suggested schedule, I suggest they should be prepared for the doctor or nurse practitioner to ask why, out of concern for the health of the baby, the family and the community at large.

Lastly, if we talk about choosing a child care provider to watch our babies when we go back to work or school, I suggest that they can ask if the child care provider and other children present are up-to-date on vaccinations.

 

Closing
As Lamaze Certified Childbirth Educators, most of what we share is about childbirth.  Yet, we are also helping new families prepare for life beyond birth, well into their little ones’ toddler years and beyond.  By focusing on the evidence-based support for vaccinations with parents as the best decision makers for their children, we are helping create healthier babies, healthier families, and healthier communities.

 

References

1. Diamond, J.  (1999). Guns, Germs, and Steel:  The Fates of Human Societies.  New York, NY, W. W. Norton & Company.

2. Offit, P. A.  (2011). Deadly Choices:  How the Anti-Vaccine Movement Threatens Us All. New York, NY, Basic Books.

Shute, N.  (2010). Desperate for an Autism Cure.  Scientific American, October, 80 – 85.

3. 2011 Recommended Immunizations for Children from Birth Through 6 Years Old. The Centers for Disease Control and Prevention.  http://www.cdc.gov/vaccines/spec-grps/infants/downloads/parent-ver-sch-0-6yrs.pdf

Posted By:  Lucy Juedes 

Lucy is an LCCE and created Birth Prep Basics, serving the needs of growing
families in Southeastern Ohio. She is also the mother of three young children.
Prior to this she worked in public relations and marketing.

 

 

 

 

Evidence Based Medicine, Guest Posts, Research, Science & Sensibility, Uncategorized , , , , , , , , ,

  1. March 29th, 2011 at 12:42 | #1

    @Tamara Morales Tamara, thank you for this thoughtful, comprehensive and sensible response! I would really like to post your question list on Duty to Inform on facebook (a page I recently created) as a reference for new parents. Do you have this question list anywhere on-line perhaps as a blog post on your blog that I can link to so that you get appropriate credit? If not, can I quote you in a note and include a link to your blog?

  2. avatar
    Karen
    March 30th, 2011 at 11:47 | #2

    @Andrea von Schoening

    Scarlet Fever is far from eradicated. You know it as strep.
    Children get it all the time, it is just easily treated now with antibiotics.

  3. March 30th, 2011 at 13:53 | #3

    @Karen
    Even before abx, deaths from scarlet fever dropped precipitously in the early 1900s (in the US at least & probably the rest of the Western world), along with just about every other disease that was rampant and/or had high morbidity/ mortality in the late 1800s. Improving health (sanitation, food supply, clean water, etc.) caused the mortality rate of just about every infectious disease (if not every infectious disease) to free-fall, before antibiotics and vaccines were available and/or widely used.

  4. March 30th, 2011 at 14:23 | #4

    @ Kathy: And yet, diseases like pertussis (whooping cough) are on the rebound, despite sanitation, clean water, access to antibiotics, etc. We have had significant outbreaks in our community for two years in a row–with the illness proving to be life-threatening to infants and causing significant morbidity to an even larger subset of the population.

  5. March 30th, 2011 at 14:40 | #5

    Karen, you make an excellent point. Not only does Scarlet Fever still exist, its sequelae do as well (potential permanent damage to kidneys, heart, auditory system & possibly brain via meningitis).

    Incidentally, Scarlet Fever (Group A Streptococcus infection) is not something babies are immunized against anyway. As a bacterial infection, it is easily (most of the time) treated with antibiotics–thus eliminating the need/interest in promoting a vaccine. There is a pneumococcal vaccine against Streptococcus pneumoniae (pneumonia-causing strep) but this is a different beast.

  6. March 30th, 2011 at 15:31 | #6

    @Kimmelin Hull

    Some diseases have cycles of infections that are not based on vaccinations rates at all, pertussis (whooping cough) being one of them. These cycles are not effected by vaccination rates…see my blog post on the subject here: http://thecrunchysideofme.blogspot.com/2011/02/pertussis-whooping-cough.html

  7. avatar
    Larissa
    March 30th, 2011 at 17:18 | #7

    Tamara- Pertussis is a disease for which the vaccine does not provide lifelong immunity for most people. We have VERY LOW booster vaccination rates among adults. This is why it keeps cycling through our population and why young babies are still at such risk from it. This is why there is such a push to get older children and adults booster shots. And like other vaccines it is not 100% effective at providing immunity, and so it is still possible for some fully vaccinated individuals to get it.

    This is a terrible example for claiming herd immunity doesn’t exist. sorry.

  8. March 30th, 2011 at 22:40 | #8

    Congrats on a great post. With all the vaccine misinformation out there on the web, it is great to see a detailed post based in science and evidence.

  9. March 31st, 2011 at 14:13 | #9

    @Larissa
    And yet it always goes back to needing more boosters, but in this case more boosters would do nothing to decrease the rate of infection…in case you missed it in my blog post:
    [Aside from poor efficacy rates, another reason why the pertussis vaccination programs are failing is that there are two different strains of pertussis, that you can actually have at the same time and only a culture will tell you what you are actually sick with. Most doctors do not confirm cases with a culture and the second strain is unaffected by the vaccine entirely. Even parts of the medical community is starting to question this vaccine and have begun to "argue over how effective they are with time and in the face of a possible increase in virulence."]

  10. March 31st, 2011 at 14:26 | #10

    @Laura Keegan
    Thank you Laura. I have actually posted about this on my blog and included links to help those wanting to ask their own questions find their own answers.

    http://thecrunchysideofme.blogspot.com/2011/03/questions-that-need-to-be-asked-before.html

    Vaccination is not something parents should take lightly and their research should go much further then asking a doctor or child birth educator for advice. They need to actively seek out their own information. It has been said that the majority of people who put in 10+ hours of independent vaccine research will decide to not vaccinate due to their findings. So should a three minute discussion really qualify as informed consent? Not in my opinion.

  11. avatar
    Mary
    March 31st, 2011 at 16:30 | #11

    I am incredibly disappointed to see such a one-sided post on this site- I am a big fan of this blog and usually share many of the posts. As a parent who has thoroughly researched, prayed over, and wrestled with every single vaccine choice I’ve made for each of my children, I’m offended at how you simplify the matter and basically tell parents not to question or look into individual risks or benefits each child may have.

    Using Paul Offit as a source? Seriously? Lucy- can you explain how you justify (for your own kids, or for the parents you teach as a Lamaze educator) the Hep. B vaccine at birth or within the first days of life?

  12. avatar
    Larissa
    March 31st, 2011 at 19:16 | #12

    Tamara, even the article you link to in your blog post says that parapertussis infection is infrequent, 1/10th the prevalance rate of pertussis in Wisconsin during the time they tested it.

    I don’t know the prevalence rate for pertussis vs. parapertussis in all the states, but even if they were the same, how do you therefore conclude that booster shots wouldn’t reduce the rate of infection? It makes no sense. If everyone got the booster shot for pertussis it is going to reduce the rate of infection, whether or not there are similar strains also going around.

    And lastly, it doesn’t always come back to needing more boosters, but in the case of pertussis it CERTAINLY does. If you are going to talk about pertussis vaccine efficacy you HAVE to talk about it and not make false claims like the vaccination rate is high and yet we have pertussis. The fact is, many infants receive the pertussis vaccination (although not as many as we would hpoe for) but many teens and adults do not get the necessary booster shot, therefore our vaccination rates are NOT high.

    Here is a fairly good story for people to catch up on the pertussis outbreak this last year
    http://www.sciencebasedmedicine.org/?p=6207

  13. April 1st, 2011 at 15:43 | #13

    @Tamara Morales

    I suppose it depends on where one does one’s research. If one already is skeptical of vaccines, it is not hard to do a google search and find an unlimited amount of absolute drek about how dangerous they are, the majority if not entirety of is spouted by ignorant fools. If one were to spend 10 hours looking at reputable scientific sources such as the Center for Disease Control documents on each vaccine currently available, I think one would be hard pressed to not want to vaccinate in almost all cases.

  14. avatar
    Kathy
    April 1st, 2011 at 22:14 | #14

    @Nicholas Fogelson, MD
    The CDC is only as reputable as the scientific sources it quotes. I certainly hope that the documents to which you are referring do better than this.

  15. avatar
    Larissa
    April 1st, 2011 at 23:58 | #15

    So true Dr. Fogelson. The internet is chock full of myths, half truths and bad science, especially when it comes to vaccines.

    Really in order to educate oneself WELL and be able to read the studies for yourself, you would need to study statistics, research methods, study design, survey design, etc. That’s what I had to do to get my MPH. Reading scientific studies is not a walk in the park. Anyone can learn to read scientific studies and reviews, but it takes a lot of work. Asking Dr. Google or reading the Mercola website doesn’t count as “researching for yourself”. (Am I going to get in trouble now?) I myself dont’ even have time to read every study on relevant topics to myself and my children, so I read published reviews and go to websites based on science. I am sure what qualifies as reputable, science based websites is where we are going to have the disagreements.

    For a fun read I recommend “Cartoon Guide to Statistics”. Definitely a fun way to learn :)

  16. April 2nd, 2011 at 22:53 | #16

    @Nicholas Fogelson, MD
    Most of my research has actually been on the CDC site. I look up their infection reports and go over their pink book frequently comparing numbers as I am a very number driven individual. I also read published studies and reviews along with news articles that have citations and then go and look up the actual sources of the citations. To me that is what it takes to research for myself and have true informed consent. I have spent nearly five years researching this in order to make the very best decision for my family.

    To me as a parent and an informed consumer it is extremely important for me to acknowledge that no vaccine is 100% affective/safe, and the cons far outweigh any pros for our family. It can be nearly infuriating when those who choose to have an intact immune system are blamed for being the ones making everyone sick since this idea is ludicrous. Diseases and our immune systems are far more sophisticated then that simple logic.

    I agree to disagree with many on this topic, but I hope that everyone does their own research and really starts asking their own questions to make the best decision for their family, as I have.

  17. April 6th, 2011 at 07:31 | #17

    I wanted to get back and touch base with with those of you who “Liked” my guest blog as well as who have commented on it and with each other. Thank you for sharing your thoughts; you’ve given me a fair amount to think about these past few weeks, and your perspectives have helped me re-shape some of how I provide vaccination information to the moms and birth partners in my Lamaze classes.

    First, I haven’t really changed my mind about vaccinations being safe and healthy for babies and children, or about the sources I consider to be experts.

    However, I think I can do a better job of communicating with the parents, thanks to some of the points some of you shared. I’ve decided to add a second handout from the American College of Nurse Midwives’ web site. The web page is called, “The Immunization Decision”, and it provides a caring, thoughtful approach.

    Second, one of the points that resonated with me the most was that vaccinations are an intervention and as such, it’s our responsibility as educators to share information about their risks and benefits. Lamaze has Six Care Practices for Childbirth, and the fourth one is “No routine interventions”. I sometimes rewrite it: “Accept only necessary interventions.”

    While the focus of my course is on preparing for childbirth, this Care Practice feels equally applicable to the new baby/mom/family care topics that I cover. So, if I’m going to cover vaccinations, I will also provide more information on why the intervention of vaccinations is considered to be necessary by the CDC, the AAP, and the AAFP. I’ll be providing photocopies from the “Materials for Parents” web pages of the CDC’s web site. These have specific, detailed information about each vaccine. There is also a page about the risks and responsibilities of not vaccinating one’s child. These I will set on a side table that people can take if they want.

    Lastly, people’s response to the guest blog also got me thinking that I would like to know more about our immune systems and diseases/epidemics. So, I went to the Johns Hopkins and Oxford University Presses and ordered a few books on these topics that I’m looking forward to reading.

    Interestingly enough, I didn’t address vaccinations in my initial course. But on the very first eval when I asked if there was anything we didn’t talk about that they wanted to know, a mom wrote in “vaccinations.” This came up with several classes, so I did some research and decided to use Robert Sears’ list of vaccinations on the standard schedule. However, we happen to get the Scientific American magazine at home. After reading more about diseases and vaccinations in SA, I started re-thinking my approach to vaccinations. Then I read Offit’s book, and I wondered why I just didn’t share the suggested vaccination schedule and information about the diseases they are for, address any questions, and refer any other questions for further research and talking with pediatricians.

    So, should we talk about vaccinations in our childbirth education classes? I think so. And the way I do it works for me and the parents in my Lamaze classes. Thank you for taking the time to share your “Likes” and thoughts on this topic.

  18. avatar
    Kathy
    April 6th, 2011 at 09:01 | #18

    @Lucy Juedes
    I’m curious if you’ve read the comments about the CDC (my comment with a link and Tamara’s comment), and how that they give quite different information on vaccines and disease to parents from what is given to health care providers. This goes beyond changing medical jargon into “lay” language, but in giving completely different numbers on how many people (especially children) are affected by or infected with this or that disease every year.

    Does this discrepancy give you any pause in considering the CDC as being fact-based? Because it does bother me that the CDC is telling parents that approx 33,000 children age 10 and younger *not* born to infected mothers acquire Hepatitis B every year, while telling doctors that the peak reported infection rate was 26,000 cases in one year (most of those through illicit drug use or promiscuity), with only about 8% of those happening in children and infants (and probably most of those were in children born to infected mothers). And it makes me not trust them, especially since they don’t cite their sources.

  19. April 11th, 2011 at 10:40 | #19

    Carol Van Der Woude just shared the following on Science & Sensibility’s FB page:

    The Greater Good Documentary on Vaccine Safety – AGE OF AUTISM
    http://www.ageofautism.com

    THE GREATER GOOD interviews leading authorities on vaccines and vaccine safety. Equal consideration is given to the doctors and scientists who advocate for universal vaccination as to those who persistently ask probing questions about regulation and administration. Call your local theater and ask them to show this film.

  20. May 25th, 2011 at 10:23 | #20

    News reports emerging: U.S. measles cases on the rise:
    http://www.nj.com/news/index.ssf/2011/05/measles_cases_reported_in_the.html

    And here is an interesting article, just out in the New Yorker, reviewing the battle between vaccination supporters, and dissenters. It covers the history of small pox destruction and elimination, as well as the (re) emerging outbreaks of measles:
    http://www.newyorker.com/arts/critics/books/2011/05/30/110530crbo_books_specter?currentPage=all

Comment pages
  1. March 25th, 2011 at 10:19 | #1
  2. April 1st, 2011 at 11:13 | #2
  3. April 3rd, 2011 at 20:40 | #3
  4. April 4th, 2011 at 01:01 | #4
  5. November 26th, 2011 at 09:20 | #5