Asking questions about vaccinations.

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Sunday, April 23, 2006 Asking questions about vaccinationsNot all parents opt for the five vaccinations recommended for young kids. Some choose, others stagger the shots. By LISA LIDDANE The Orange County Register It's a question Dr. Bob Sears increasingly hears from new parents, a question for which the San Clemente pediatrician wishes he had a simple answer. "Does my

child need all those vaccines?" Infants and toddlers have been getting as many as four shots in one visit. And with the addition this year of RotaTeq – a new rotavirus vaccine – to the kids' immunization schedule, the maximum shot load has risen to five. But to accommodate parental concern about the safety of vaccines, Sears' young patients typically receive no more than two shots per visit. Sears' flexible approach is unorthodox and uncommon, but it's one of several ways a handful of doctors and a growing number of parents are dealing with vaccine worries. "Reports of staggered vaccinations are true," said Dr. Jasjit Singh, associate director of pediatric infectious disease at Children's Hospital of Orange County. Some parents are choosing not to vaccinate at all, Singh said. Others are picking and choosing vaccines that their children are going to get. Singh said that although she has no specific

statistics, she has noticed that more educated, middle-to-high income families are opting to forgo vaccinations. Parents worry that some vaccines can increase risk of asthma, autism and learning disabilities. This month, the vaccine debate intensified. An outbreak of mumps in nine states over the past eight weeks has tripled the number of mumps cases usually reported in the United States over a full year. Mumps is one of several diseases close to being eliminated in the United States. Though no deaths have been attributed to mumps, the disease can cause deafness in children and sterility in men later in life. But the vaccine for mumps, measles and rubella, MMR, is the one parents are most likely to worry about. The MMR vaccine is at the core of the immunization debate because some researchers and parents believe thimerosal used as a preservative in the vaccine can cause autism. Thimerosal, a compound containing mercury, has been

removed from children's vaccines, except for trace amounts, according to the federal Centers for Disease Control and Prevention. A review of studies does not show a link between vaccines with thimerosal and autism, according to the Immunization Safety Review Committee of the Institute of Medicine of the National Academies. But some parents and doctors are not convinced that enough research has been done. A study in the Journal of American Physicians and Surgeons in March showed that autism and other neurological disorders decreased after mercury was removed from children's vaccines. The controversy is heating up all the way from pediatricians' clinics to the halls of Congress and the CDC offices. On April 6, autism activist groups accused the CDC in a full-page ad in a national newspaper of covering up knowledge that mercury in vaccines caused the rise of autism. The CDC, which issues the immunization schedule, denied the accusation. A panel from the

National Institute of Environmental Health Sciences will meet in May to address a study about whether the incidence of autism decreased after thimerosal was removed from or substantially reduced in most vaccines. The results of that study won't make a difference to Melissa Cox, who began scouring the Internet and reading about vaccines before she became pregnant with Easton Cox, now 14 months. "After I told my husband what I found out about vaccines, he said, 'There is no way we're vaccinating.'" That was the easy part. Finding a pediatrician who would agree to their wishes wasn't. But she eventually found one. "Easton's pediatrician said, 'I disagree with your beliefs, but I'll see your son," said Cox, 26, of Huntington Beach. "At Easton's two-month visit, the doctor offered the shots. I declined. At the four-month visit, she stopped asking." Cox said her son's excellent health is a testament to his vaccine-free existence. She

said she believes that allowing her son's immune system to fight infection without the help of vaccines makes his body tougher. He's had only minor coughs and one bout of an ear infection, Cox said. Kelly Grijalva's son, Andrew, stopped receiving vaccines after his two-month visit. "When we told his pediatrician that we didn't want him vaccinated, she walked away and said, 'That's not being a good parent,'" recalled Grijalva, 23, of Costa Mesa. "Why would I want these chemicals in my baby's body?" she said. "If he catches a disease and dies from it, then that's God's will. I'd prefer that to him dying from a vaccine I purposely allowed him to have." Cox and Grijalva are acutely aware that many parents don't agree with their beliefs, but they also add that many of the diseases for which kids are routinely vaccinated are no longer serious threats in the U.S. "While many diseases indeed have been mostly eliminated in the U.S.,

they're certainly not eradicated in other parts of the world," said Daniel Salmon, associate director for policy and behavioral research at Institute for Vaccine Safety at Johns Hopkins University in Baltimore, Md. Salmon, also associate professor of epidemiology at the University of Florida in Gainesville, Fla., cites polio as an example of a disease that does not exist in the U.S. but is still a threat in developing countries, and potentially to the U.S. In an era of frequent global travel, it's possible for such diseases to resurface in the U.S. and cause unvaccinated children to become seriously ill or die, he said. Parents need to remember that vaccines have been largely responsible for preventing many deaths and health problems from numerous childhood diseases, CHOC's Singh said. Vaccines are more than a family health issue – they are a public-health matter, she added. "If you don't have your children vaccinated, you're counting on the

herd immunity of the population and putting not only your children but others around them at risk for preventable diseases," Singh said. "Vaccines are excellent, but they're not 100 percent protective." Parents also need to better scrutinize their sources of vaccine information, she said. Parents may be getting biased and inaccurate information, she said. Vaccines are relevant, but the busy nature of managed-care practice makes it difficult for doctors who see children to spend a lot of time discussing the risks and benefits of each vaccine, Salmon said. Giving parents some flexibility with the immunization schedule is a much preferable option to children not getting vaccinated at all, said Sears, who is finishing "The Vaccine Book." The vaccination schedule has some room for spreading out the vaccines, especially when a child reaches 6 months old. "You decrease the exposure to a variety of chemicals if you spread out the vaccines,"

he said. "The only downside for parents is the extra driving and extra co-pays." Copyright 2005 The Orange County Register | Privacy policy | User agreement "Our ideal is not the spirituality that withdraws from life but the conquest of life by the power of the spirit." -

Aurobindo.

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