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Just Shoot Me: An Opinon on Vaccines

All About Vaccines

I have found being dogmatic in things pediatric to be a perilous business; practice evolves, recommendations change. For parents, the seemingly ever-shifting vaccine schedule — a dizzying array of alphabet soup — can be understandably overwhelming.

What I Preach
Depending on whom you ask, vaccinations might be described as one of the greatest advances in modern medicine. Since Edward Jenner's brainstorm to use cowpox to inoculate against smallpox in 1796, immunizations have likely saved more lives than any other medical intervention. Vaccines work great almost all of the time, reducing the likelihood of developing the diseases in question by well over 90 percent. Ladies and gentlemen, that is a wow.

Of course, if you ask most children just after their fourth birthday, when a number of boosters are scheduled, they may beg to differ. "What are you doing to me?" yelled one assertive girl in my office. It was a great question. A developmentally sensitive attempt to respond to her query — delineating her reduced lifetime risk of developing devastating diseases because of her shots — was not well received.

Admittedly, vaccines aren't perfect. The withdrawal from the market of a rotavirus vaccine several years ago tells us they are not always successful. But those instances are by far the exceptions. We have it really good here: In the U.S., the effectiveness and safety of vaccines are tracked before, during, and after they're brought into use. Severe side effects are exceedingly rare. For the pneumococcal vaccine, for example, which prevents the worst of blood and brain infections by strep pneumococcal disease, the chances of a severe reaction are less than 1 in 10,000.

What I Practice
As parents, my wife and I have our children vaccinated. The risks are far less than those of the diseases we're protecting our kids from. In my practice, I follow the vaccination schedule but keep an open mind and an ear to the ground (and my metaphors mixed) about the state of the art and the safety and effectiveness of what we are doing. While parents may think the vaccine schedule looks suspiciously like a timeline to get as many needles in those little bodies as quickly as possible, the timing of the shots was developed to sync with our kids' evolving immune systems and disease risks.

So is the vaccine schedule flexible? Theoretically yes, but it isn't designed to be à la carte. Some families may ask for an alternative timetable or to have combined shots (e.g., the measles, mumps, and rubella — or MMR&mdash ;vaccine) given separately, but I haven't found any data that suggests either has any advantages. Giving immunizations over a longer period can slow the rate at which a child develops full immunity to a disease (it might be 80 percent after one shot but approaches 98 percent or more after all shots are given).

I'll tell concerned parents which immunizations have the highest priority, based on the child's age and potential threat the diseases could pose. For an infant I might suggest the diphtheria/tetanus/whooping cough (DTaP) or Hib vaccines, or the vaccine against strep pneumococcal disease (I mean, who needs meningitis?). Sometimes it helps for families to think it over and come back just for a "shot visit" if they're anxious or want to do more research.

This will continue to be a confusing area; it keeps on changing. (That's why, as a resident, I carried a vaccine cheater card in my pocket. It was like a shifting train schedule.) Whether we are pro-vaccines or ambivalent about them, we're all pro-child. Ask your questions, express your concerns. For parents, this is scary, actuarial decision making. Part of our role as health providers is to explain what we're doing and why. At the end of the day, we all seek to do no harm.

Do Vaccines Cause Autism?
In the 1990s, a British study of 12 children suggested a link between autism and the MMR vaccine. Elsewhere, the mercury-based preservative thimerosal (formerly common in vaccines) was implicated. But more than a decade of solid, transparent, and credible research — including the best minds of the Institute of Medicine, the American Academy of Family Physicians, and the World Health Organization — has failed to find a true connection. In fact, 10 of the 13 authors of the original study have retracted the paper's interpretation. Unfortunately, we haven't yet decoded what does cause autism. (For a more in-depth discussion, visit metrokc.gov/health/immunization/qavaccines.htm.)

By the Numbers

  • 4 — Number of vaccines children routinely received in the 1950s.
  • 11 — Number of vaccines children commonly receive today, resulting in more than 30 shots by age 6.
  • 20 — Number of states that allow parents to opt out of vaccinations for personal or philosophical reasons.
  • 48 — Number of states that allow parents to opt out of vaccinations for religious reasons.
  • 85 to 99 — Percentage of unvaccinated people who develop chicken pox after being exposed to the disease.

Tips: How to Make the Shot Visit a Little Easier on Everyone

  • An ingestion of breast milk, formula, or a dose of sucrose sweetened solution (via syringe or binkie) 1 to 2 minutes before the shot (or even nursing throughout)
  • Choices and control— let older children choose which arm
  • Non-nutritive sucking (thumb or binkie)
  • Distraction/coaching (my friend Dr. T. Berry Brazelton tells moms to scream along with their kids and then dance around the room)
  • Premedication: I'm a big fan of a slug of acetaminophen beforehand
  • A sticker afterward, natch

About the Author
Jack Maypole is a pediatrician at Boston Medical Center and director of pediatrics at the South End Community Health Center. While a bit of a needle coward himself, he got another flu shot this year.

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