- The Washington Times - Sunday, July 22, 2001

The rumors about vaccines scared Suzanne Walther almost as much as any potentially lethal germs.

The Murfreesboro, Tenn., mother of three had heard and read a wide array of information about vaccinations as she had prepared for the birth of her daughter, Mary Catherine, two years ago.

She had read the Internet, listened to friends talk, flipped through magazine articles. She had learned about children getting sick from vaccines and read about how giving so many shots at once can overwhelm the immune system. She had heard about children developing autism, diabetes or allergies, possibly as a result of vaccines for illnesses her child probably would never get.

"I was just amazed at the overwhelming amount of information out there," says Mrs. Walther, whose two older children had been fully vaccinated. "I said, 'Until I know more, I cannot go ahead and do this to my baby.' I couldn't find anything that convinced me that the scary stories were not true."

The Walthers decided to postpone Mary Catherine's vaccinations until she was a year old. That would give them time to do more research.

That decision seemed to be the right one as Mary Catherine was a healthy, happy baby for nearly 12 months. One week before her first birthday, however, she contracted meningitis, a potentially lethal illness that could have been prevented with the Haemophilius influenzae B (Hib) vaccine.

Mary Catherine spent 10 days in the hospital, undergoing a spinal tap and antibiotic therapy. It was the first case of Hib the hospital had seen in eight years.

The toddler eventually recovered without complications. She since has been fully vaccinated. Mrs. Walther is now convinced that vaccinations are safe and necessary.

"It takes a lot of cynicism and ignorance not to vaccinate," she says. "There are risks to those choices. Getting correct information is crucial."

In an era when modern medicine has virtually wiped out illnesses such as polio, measles and rubella, some people have lost sight of the reason for vaccines to prevent them, says Dr. Paul Offit, chief of infectious disease and director of the Vaccine Education Center at Children's Hospital of Philadelphia.

"Vaccines were an easy sell for my generation," Dr. Offit says. "Our parents grew up with measles, polio. When I was a resident 20 years ago, doctors saw 20,000 Hib cases a year. Since there has been a vaccine for it , there are maybe 100 cases a year. For young mothers today, they have not seen those diseases. That, combined with a greater level of distrust and sensational stories, has made some people wary of immunizations."

Two recent reports indicate that as the United States' immunization levels have grown, so have misconceptions.

The Centers for Disease Control and Prevention says 80 percent of American preschoolers have been immunized, the highest level in history and a dramatic jump from 55 percent in 1992.

Dr. Bruce Gellin, associate professor of preventive medicine at Vanderbilt University and executive director of the National Network for Immunization Information, conducted a phone survey of 1,600 parents of young children. His results were published in an article in the journal Pediatrics last November.

Eighty-seven percent of respondents said they deemed immunization an extremely important action parents can take to keep their children well.

One-quarter of respondents, however, also believed that their child's immune system could become weakened as a result of too many immunizations. Twenty-three percent said they believed children are given more vaccines than are good for them.

Concerns about vaccines can erode public confidence, which may lead to more people declining the full course of vaccines, which is now 23 doses to combat 11 illnesses. That is a dangerous road to go down, Dr. Gellin says.

"With the exception of smallpox, which was eradicated more than 20 years ago, many of these diseases are only a plane ride away," he says.

Seeking control

Barbara Loe Fisher says she is not against vaccines; she is for information and choices. As the immunization schedule has grown, so have Ms. Fisher's concerns.

"When the CDC started recommending that all children have the hepatitis B vaccine when they were 12 hours old, that is when we really saw more parents coming to us with more questions," says Ms. Fisher, president of the National Vaccine Information Center, a Virginia-based advocacy group.

"It is the instinct of parents to want information and choices as to whether we want to vaccinate," she says. "We want to minimize the risks and maximize the benefits. We want control over how many vaccinations and when. Many parents feel they are being forced into vaccinating rather than making a voluntary decision. In the end, the parent is going to be left with the consequences of a decision for the rest of his or her life."

Ms. Fisher points to the rise in autism, type II diabetes, even attention deficit hyperactivity disorder in the past two decades. Though no mainstream scientific research has found a link between these conditions and immunizations, she says it is "scientifically illogical to assume vaccines have not played a role in growing illness in children."

"We have got to find out the biological markers to determine who is genetically susceptible to these diseases," says Ms. Fisher, who founded her organization after her son developed cognitive disorders after getting the pertussis vaccine.

She says 50 percent of vaccine-related injuries could be avoided if children were not vaccinated when they were sick (such as with an ear infection); if doctors avoided vaccinating a child who had had a previous vaccine reaction until further testing was done; if health care professionals took a more thorough family history to see if a child is at risk for severe auto-immune problems; and if vaccines were spaced out a bit more. (Some children get up to four shots in one visit.)

"When in nature are you going to come in contact with five viruses in one day?" Ms. Fisher asks.

Dr. Offit says there is no danger in a child getting several shots at once. A human is exposed to 10 million to 1 billion antigens at one time, he says. That is much more than what is contained in an injection.

"From the minute we are on this earth, our skin, nose, intestines, our bodies are colonized tens of thousands of bacteria to which they are immune," he says. "The vaccines given in the first two years are literally a raindrop in the ocean of what infants' immune systems successfully encounter in their environment every day."

Not risk-free

Even though vaccines go through a strict approval process for the Food and Drug Administration and are deemed by public health officials to be among the most important health innovations of this century, there are some risks. The federal government has a Vaccine Adverse Event Reporting System in place, to which some 12,000 reactions are reported voluntarily each year.

The majority of those reactions are mild, such as fever or rash at the immunization site. About 20 percent are deemed serious, such as seizures, according to the CDC.

Leslie Cadenet's son, Graham, had a reaction after he received a dose of the DTP (diptheria-tetanus-pertussis) vaccine at age 7 months. After receiving five vaccines that day, Graham lost consciousness, and his blood pressure dropped to dangerous levels, Mrs. Cadenet says.

Graham, now 2, recovered within a few hours, but his parents have opted to stop future vaccinations.

"No one wants to see their child get sick," Mrs. Cadenet says. "I get upset when he gets a skinned knee. When doctors come up with a way to find out which component he is sensitive to, maybe we will reconsider."

Parents who opt not to immunize will have to cut through some red tape when it comes to travel or education.

State laws require immunizations for school entry, but the District and most states including Maryland and Virginia provide an exemption for religious beliefs or medical conditions. An additional 15 states offer a philosophical exemption. To travel internationally, where the risks of vaccine-preventable diseases sometimes are greater, travelers need to be immunized.

The Cadenets say they will consider home-schooling their son, and even if they do not, they will get their physician to sign a medical exemption.

Nora Horsfall, a Pennsylvania mother of a 4-month-old who has not had vaccines, says she eventually might get her son vaccinated. If not, she will seek a philosophical exemption.

"If someone ever convinces me they are safe and effective, I will do it then," she says, "but if it is proven they are not safe, then I can't take them out of my baby."

Advocates such as Dr. Gellin and Dr. Offit are seeking to change the skepticism of parents such as Mrs. Horsfall and Mrs. Cadenet.

"There is no such thing as a risk-free choice," Dr. Offit says. "When you eat solid food, you are risking choking. But what you want to do is put your child in the safest position possible."

Dr. Offit points out that vaccine formulas have been changed recently to enhance safety. The polio vaccine, for instance, used to be four doses of a live virus. It was effective, but there were rare cases of children getting the disease from the live-cell oral vaccine. That since has been phased out in favor of the killed virus, which is injectable.

Some parents also have been concerned about thimerosal, the mercury-containing preservative found in multiple-dose vaccines such as the one for measles mumps and rubella (MMR) and DTP.

An FDA examination in 1999 found that children were being exposed to more than twice what the Environmental Protection Agency deemed safe for young children. The amounts did not exceed the FDA recommendations, but the formulas since have been changed to contain less thimerosal.

"The guidelines are set up with significant levels of safety," Dr. Gellin says. "It is not as though getting one molecule more than recommended is unsafe."

A common parental concern is that a child can suffer other ill effects from a vaccination, such as falling victim to sudden infant death syndrome after the hepatitis B or DTP vaccine or developing autism from the (MMR) vaccine.

CDC experts have concluded there is no link to SIDS and vaccines. Two panels assembled recently by the American Academy of Pediatrics and the National Academy of Sciences looked at the MMR-autism connection. They concluded that there is no link, although they still cannot pinpoint what causes autism.

"It is understandable why think there is a connection," Dr. Gellin says. "Signs of autism may appear in the second year of life, when you have gotten the MMR and just when you are waiting for social skills to develop and they don't. But scientists have looked at the data and said the facts just aren't there."

Dr. Gellin says it is important for parents to understand scientific research and get their information on vaccines from reliable sources such as accredited medical institutions, their physician or the CDC.

"People really need to talk to their doctors," he says. "Just because they have questions about vaccines, it does not mean they are anti-vaccine. If they are not getting reliable information from their doctors, then who are they going to get it from?"

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