Vaccine Info for Masie
My sister is expecting a baby near the beginning of February: my first debut as an auntie! I’m so excited!
She’s in Portland and feeling a lot of pressure from the anti-vaccine crowd. In her words: “They make me feel like an awful person [for choosing vaccination], they tell me my child will hate me forever.” She knows I am a strong proponent of vaccinating for most preventable childhood diseases, so she asked me to put together some links and information for her.
Let’s start with the claim, often heard on Internet messageboards or sometimes from celebrities, that vaccines cause autism. They don’t. This claim began with a fraud, a paper published in The Lancet (a famous and well-respected medical journal) that was later withdrawn after it was found that the author had manipulated data and had multiple undisclosed conflicts of interest. That paper was a hoax and the author was later stripped of his medical license. But it set off a panic.
Since that time there have been a lot of studies—involving millions of children in several countries—and it turns out that there’s simply no difference in autism rates among those who are vaccinated and those who are not. The American Academy of Pediatrics, the CDC, the World Health Organization, and the Institute of Medicine all agree that there is no link between vaccines and autism. The scientific consensus on this question is so strong that it is, frankly, no longer a question. It’s a settled fact. Vaccines do not cause autism.
Vaccines do sometimes have side effects, though. Sometimes they have serious side effects. It’s rare, but some vaccines can trigger seizures or cause very high fevers. So in considering whether or not to vaccinate, we have to do a risk trade-off analysis. Which is riskier, the vaccine or the disease?
Several years ago, many parents were able to look at diseases like measles and whooping cough and say, wow, these diseases are really rare. I’m not sure that I want to give my child this vaccine when they probably won’t even be exposed to the disease in the first place.
That reasoning is not irrational, but it depends on assumptions that are no longer true. Measles and whooping cough are both surging back. Other diseases, like polio, are worth vaccinating for even though the disease remains very rare in the U.S., because the polio vaccine has no serious side effects and in an age of global travel, a resurgence of polio is only one plane ride away.
I think the rational thing to do is to research each vaccine and consider the risk/benefit tradeoff separately. This is a fantastic website that goes through each vaccine and explains the risks associated with the vaccine versus the risks associated with the disease. In most cases the best choice is to vaccinate. For instance, on the pertussis vaccine:
Do the benefits of the pertussis vaccine outweigh its risks?
This question is best answered by taking a look at the side effects of the old pertussis vaccine. The old pertussis vaccine had a high rate of severe side effects such as persistent inconsolable crying, fever higher than 105 degrees, and seizures with fever. Due to negative publicity surrounding this vaccine, the use of the pertussis vaccine decreased in many areas of the world. For example, in Japan, children stopped receiving the pertussis vaccine by 1975. In the three years before the vaccine was discontinued, there were 400 cases of pertussis and 10 deaths from pertussis. In the three years after the pertussis vaccine was discontinued, there were 13,000 cases of pertussis and 113 deaths from pertussis! It should be noted that although the side effects of the old pertussis vaccine were high, no child ever died from pertussis vaccine.
The Japanese Ministry of Health, realizing how costly its error had been, soon reinstituted the use of pertussis vaccine. The children of Japan proved that the benefits of the old pertussis vaccine clearly outweighed the risks. The new “acellular” pertussis vaccine has a much lower risk of severe side effects than the old “whole cell” vaccine.
Pertussis is very common in the United States. More than more than 41,000 cases of pertussis and 18 deaths were reported to the CDC during 2012. However because of underdiagnosis and misdiagnosis, this number is likely to be a vast underestimate of the number of cases that actually occurred. It is estimated that most years between 600,000 to 900,000 cases occur in adolescents and adults. Sadly, most of the deaths from pertussis occur in young infants who struggle to breathe against a narrowed windpipe, leading them to turn blue or suffer spells of apnea. Because the pertussis vaccine does not cause death, the benefits of the pertussis vaccine clearly outweigh its risks.
A few things you can do if you remain concerned about risks associated with vaccines: make sure your pediatrician uses thimerosal-free vaccines. Ask the pediatrician about a delayed/alternate schedule for vaccination—I would not, however, delay DTaP given the resurgence of whooping cough. Personally, after doing our research, we stuck with the recommended vaccination schedule. But a delayed schedule is definitely better than not vaccinating at all.
I think the vaccine question is for the far left what the climate change question is for the far right. In both cases there is a very strong scientific consensus, and in both cases there are groups of people who passionately dispute that consensus. I am pro-science in both cases.
Having said that, I want to make it clear that I think there are valid grounds to critique the pharmaceutical industry, the lack of regulatory oversight around vaccines, et cetera. I think coming at these questions from a skeptical point of view, and doing your own research, is not a bad thing at all.
But I do think vaccine refusal is a bad thing.
On most parenting issues I am very “live and let live,” but fighting preventable diseases is an issue that affects society as a whole. In every population there are some—babies, the elderly, the immunocompromized—who are most likely to suffer or die from these illnesses, and sometimes these are people who can’t get vaccinated or for whom the vaccine is less effective. These most vulnerable people have to rely on what’s called herd immunity, and herd immunity only works when a high percentage of the population is vaccinated. So those who choose not to vaccinate are putting not just themselves or their kids at risk, but my baby and a lot of other people as well. I can’t view this issue through the rubric of individual choice. There really is an element here that’s about our responsibility not just to our own kids but to the communities we are part of, and especially to the most vulnerable among us.
And I also think it’s important to remember that these illnesses can be terrible. There was a video going around a while back of a baby racked by whooping cough. I knew I couldn’t watch it, and I don’t recommend you watch it either, but keep in mind that the severe coughing fits caused by pertussis can literally break a child’s ribs. Chicken pox can cause permanent brain damage. Measles can cause blindness. If you’re dwelling on the risks associated with vaccines, force yourself to dwell a little bit on the risks associated with the actual disease as well. Because none of these illnesses are trifling.
Vaccination is a hot-button topic, so I will be moderating comments closely. Respectful disagreement and friendly debate is always welcome, but I won’t hesitate to delete comments that veer toward personal attack.
September 14th, 2013 at 2:22 pm
I’d kindly, or maybe not so kindly, tell them to, well, you know. There aren’t too many issues that make me see red as anti-vaxers and the home birthers. UGH. Seriously. I stumbled on blog recently that may help her. I know from reading the comments that the author, an obstetrician gynecologist, through cold hard scientific based logic has changed some of those who felt this enormous, but oh so misguided, pressure from this insidious magical thinking and has even managed to persuade some true believers. One point: The reason their children are protected, not fully but that’s another conversation, from these horrible and mostly preventable diseases through exclusive breastfeeding is because these mothers were vaccinated!
http://www.skepticalob.com/
September 14th, 2013 at 2:41 pm
I’m actually not at all opposed to home birth in low-risk cases, when the plan is to transfer to a hospital as soon as complications arise. There’s solid research showing no increase in perinatal mortality in those cases (http://www.ncbi.nlm.nih.gov/pubmed/9271961). So that’s an area where I am totally “live and let live.”
I part ways with those who are SO anti-hospital that they will stick out a home birth even in the face of dangerous complications. But again I mostly even see that as part of a woman’s right to determine her own medical care.
September 14th, 2013 at 2:30 pm
P.S. A bit off topic, but I wish I had found this site when I was struggling to switch to exclusive bottle feeding. It would have saved so must heart-ache and alleviated the nearly all-encompassing guilt. 🙂
September 14th, 2013 at 3:03 pm
So I browsed that site. I dunno, she seems really hostile and polarized. Her positions are mostly the same ones I chose for myself, but her attitude seems really judgmental. I have a lot more sympathy than she does for the women who make different choices.
I *even* have sympathy for vaccine deniers, actually. I think they are almost all well-meaning people who made (or were pressured into) a bad choice based on faulty information and media hype. And it’s not like there aren’t valid reasons to distrust the pharmaceutical industry.
We’re living in an age where a lot of people are skeptical (and sometimes for good reasons) of “experts” and the medical establishment. Lots of people trust what they hear from their neighbors and friends more than they trust their doctors. I think that’s part of why those of us who are alarmed by the resurgence of preventable childhood diseases do need to speak up about vaccination, but I do want to do that in a way that’s basically friendly and respectful.
I mean, I really object to the self-righteousness and judgmentalism that comes from some corners of the “natural birth!” “breast is best!” “time-outs are child abuse!” crowd. So I don’t want to fall into the trap of replicating that from the other side.
September 14th, 2013 at 6:06 pm
She is blunt, and yes, polarizing. Dr T has a long and contentious history with the fringe home birthers and anti-vaxers that clearly affects the tone. I think her blog used to be milder, but over the years she discovered that there is no middle, reasonable ground with these specific people. She’s done. I’m not making excuses so much as trying to put it into context. But one consequence of her calculate hardline stance is loosing a portion of those like you who wish to approach these issues in a more nuanced way.
OTOH, her blog is one of the rare instances where I don’t weep for humanity when reading the comments. In fact the comment contributors on the whole are level-headed and not nearly as contentious as the entries. The comments have persuaded me far more than the prompts.
I’m also not opposed to low risk at home births with the strong caveat for a firm plan b. A seemingly normal birth can turn into an emergency situation rapidly. Case in point – me. Where we may part ways is that the baby is equally involved in labor. I agree that any adult has the right to choose their own medical care, but the baby does not have this choice. I also have little sympathy for those who do not vaccinate their children for the same reason.
September 14th, 2013 at 6:31 pm
If the blog itself is not useful for you, which I do understand, what might interest you is Amy Tuteur is currently in a lawsuit with another blogger over DMCA abuses ‘to silence critics.’ The outcome could (will?) set precedence in one direction or the other and I’m very interested in the outcome.
The impetus behind this lawsuit might help explain why she approaches these issues the way she does. Or maybe not. I dunno. I don’t agree with all she writes, and the tone is off putting at times, but it drives the fringe element batty, and for this I applaud her.
Here’s a fairly neutral article on the lawsuit.
http://www.techdirt.com/articles/20130129/03584521813/copyright-as-censorship-birth-blogger-fight-goes-legal-over-dmca-abuse.shtml
September 14th, 2013 at 6:49 pm
Ugh. I am allllllll the way with her when it comes to people using the DMCA to try to silence her. Not a fan of censorship, to put it mildly.
September 16th, 2013 at 8:21 am
Oh, man, that DMCA takedown attempt is baaaaaaaaad. Somebody on the tech blog said something along the lines of “bad laws are asshole magnets”, and it certainly seems to be true.
It’s an ill wind that blows no one any good, though. I just learned that the technical name for the bird is digitus impudicus. I had no idea!
I actually was pretty familiar with Amy Tuteur’s site at one point when this was a relevant issue for me. Agree that she’s long on rage and short on diplomacy, but I’m sympathetic to her frustration, and even more so on the other side of my own c-section. It wasn’t obvious until they cracked me open that Silas was badly impacted; the derided for-fetal-distress-after-cascade-of-interventions c-section probably saved me a nasty birth injury, if it didn’t save his life (assuming that a home birth would have gotten us to the hospital eventually). Anecdata, yeah, but it’s colored my feelings.
Wish both sides could work together (ha! ha!) to make more birth center-type options available.
September 15th, 2013 at 1:48 am
Good for you. It’s also useful, I think, to keep in mind that antivaccinationism has been around since the first vaccine was invented. The original argument was that preventing disease through vaccination was defying the will of God. Since that time antivaccinationism has been with us, though the arguments change every few decades — if the antivaxers can be made to give up on the autism thing, they’ll find something else. What it boils down to, I think, is that needles are scary, especially when stuck into babies.
September 16th, 2013 at 9:32 am
That’s a good point. But we’re seeing something new happening right now, with these diseases that were once on the verge of eradication surging back. It would be too simple to blame it all on the anti-vaxers–a lot of it was that the vaccines were changed to dampen side effects, and we’re now starting to see that the protection they confer wears off earlier–but it is *more* important to vaccinate now than it was several years ago.
September 15th, 2013 at 10:07 am
Excellent.
September 15th, 2013 at 10:25 am
Thanks Todd!
September 15th, 2013 at 4:16 pm
Shannon,
I found your blog post via Todd/FB. Thank you for writing this, I will be sharing a link on FB hoping that my sister will read.
regards,
Doug
September 15th, 2013 at 7:04 pm
I hope it’s helpful!
September 16th, 2013 at 7:14 am
Very nice! I know I’ll be pointing people to this page in the future. Shannon, you are an official Internet Resource.
Masie, something to consider is that it is also possibly to minimally delay but yet spread out vaccinations (2-3 weeks between each one, and not combined when possible). We did this because it seemed very plausible to my wife, a postdoc who does a lot of immunology, that doing so would both
a) reduce the severity of (annoying, not dangerous) side effects, like fever, fussiness, and soreness, and most importantly
b) improve the immune response and thus result in stronger immunity.
Spacing vaccines is something that’s normal in the cattle industry, but human public health is governed by concerns sociological as well as medical (i.e. spacing them out greatly increases the burden on parents as far as having to schlep to the doctor, and thus reduces compliance). And it isn’t so your kids won’t be hideously damaged and hate you, it’s so they’ll get MORE of that vacciney goodness.
I don’t think it’s a big deal, but if fussing the details makes you feel better, then it’s something to consider.