This mom’s vaccine decisions

As soon as I heard Dr. Bob Sears would be releasing a book to help parents make vaccine decisions, I pre-ordered it and waited two months for it to be published and arrive on my doorstep.

The Vaccine Book: Making the Right Decision for Your Child (Sears Parenting Library)was well worth the wait. Finally, I was able to read detailed information about each vaccine choice available for my children. Dr. Sears thoroughly investigates all the options and lays them on the table for parents to decide. I worried that this approach might be a little wishy washy and leave me with more questions than answers, but he manages to get everything out there.

I’ve read plenty of pro-vax and no-vax literature. Most is either staunchly against any immunizations or suggests that parents should ask no questions and just do what the nice doctor says. There are even a few things written somewhere in between, in which the authors present their recommendations. It’s hard to find something that presents all the facts so parents can make educated decisions. This book did it for me.

The Vaccine Book is very readable. Dr. Sears writes in language a layperson like me can easily understand. His conversational style makes it feel like he’s sitting and talking to me. He’s even a little funny at times. I especially enjoy his use of Star Trek wisdom (p. 220).

He goes through each of the 12 standard vaccine choices and answers the same questions for each vaccine-preventable disease: Is it common? Is it serious? Is it treatable? When is the vaccine given? How is the vaccine made? What ingredients are in the final solution? (Including “Are any of these ingredients controversial?”) What are the side effects? Should you give your baby this vaccine? (Includes reasons to get it, reasons some people choose not to, travel considerations, and options to consider when getting it.) He ends each chapter with “The way I see it” summarizing key factors, yet he does not send a message that parents must do it one way or another. He covers special vaccines for travel and combination vaccines that reduce the number of shots given. There’s a chapter for parents who decide to delay or decline vaccinations and one called “What Should I Do Now?” He offers Dr. Bob’s Alternative Vaccine Schedule near the end of the book. It ends with 20 pages of additional resources in which he summarizes journal articles.

Reading The Vaccine Book left me confident I could make the right vaccination decisions for each of my children.

And a big plus for me: He recognizes breastfeeding as a way to reduce disease risk. On his list of eight ways to boost your child’s immune system, “breastfeed” is No. 1.

The web site http://www.thevaccinebook.com/ promises online updates to the book as vaccines and data change. There’s also a forum, blog and other resources.

After digesting the book page by page, here are my decisions and the reasons that are important to me.

Haemophilus Influenzae Type B (HIB)

It’s unlikely Dori would get this disease past age 3, so we will end the series. She got 3 of 4, which is considered as completing the series anyway — I suspect because she got them when older. Addy already had hers (and then some — the extra, accidental TriHIBit). I might consider this one for a new baby, beginning at 2 or 3 months.

Makes me more comfortable about the vaccine

• Can’t get disease from vaccination.

Concerns me about the vaccine

• Guillian-Barre Syndrome is a reported side effect, though the risk of a severe case seems lower than with other vaccinations. (My niece was diagnosed with G-B as a child, so this one is important to me.)

Pneumococcal

This disease is worse in infants and the elderly. It mostly affects children in the first two years. Since Dori is already past infancy and almost 2, we won’t finish this one. I might consider it for a new baby. Because Dori is breastfed and not in day care, so her risk of catching the disease is lower anyway. Addy is also past this. Both got the first 3 shots, but not the 4th, typically given at 15 months.

Makes me more comfortable about the vaccine

• Can’t get disease from vaccination.

Concerns me about the vaccine

• Contains aluminum.
• 10-15% of children get standard side effects.
• Guillian-Barre Syndrome is a reported side effect.

Diphtheria, Tetanus and Pertussis (DTaP)

Because Dori is past the first six months of life when pertussis (whooping cough) is serious, we won’t finish this series. She had the first 3 doses of 5. Diphtheria is virtually nonexistent in the U.S. and there is a very low risk of tetanus in children younger than age 5.

I might consider this one for a new baby because pertussis is common. I wish only the pertussis vaccination could be given without the D and T, but that is not possible.

Addy already had the 4-shot DTaP series (plus an extra TriHIBit combo due to nurse error!), but not the 5-year-old booster. She will get the DT booster soon (she is 5).

I asked Dr. Sears on his online forum if the accidental dose of TriHIBit she Addy was given at 7 months could have given her enough DTaP that she has D and T immunity. The nurse made a note in her record that it “doesn’t count,” but I don’t care about what satisfies the public health record. I want to know about her immunity. Dr. Sears responded the same day and said, “No, getting that extra shot at so young an age wouldn't give extra immunity years later.”

On page 227 of The Vaccine Book, Dr. Sears says a titer can be done for tetanus (viral). Titers can be done for diphtheria and pertussis (I’m not concerned about pertussis), but it’s unknown whether a positive result means adequate immunity from bacterial disease like these.

Like Addy, Dori will get the DT vaccine (big d, big t, no pertussis) at age 5, 6 or 7. Dr. Sears says, “It shouldn’t be used for older kids because they may react to the high D component.” They could get just the T or dT, but the aluminum is higher in those and they may as well get full protection from diphtheria then because of possible international travel. I’m not sure how many doses of DT would be required for Dori.

I’ll also consider diphtheria vaccination for any future children when older because they may travel to affected areas (Belarus had an outbreak while we were there) and because we may want to contribute to the herd effect.

Tetanus can be treated with a suspicious injury. I made a note in our emergency medical record that the girls have not had all the tetanus shots so they can be treated appropriately if either gets a deep, dirty wound.

Makes me more comfortable about the vaccine

• Can’t get disease from vaccination.

Concerns me about the vaccine

• Guillian-Barre Syndrome is a reported side effect and mainstream researchers show causal effect from the tetanus vaccination.
• 15% show standard side effects (among the higher of all the vaccinations).
• DTaP contains more chemical components than other vaccines.

Hepatitis B

It’s transmitted by sexual activity and intravenous drug use, so no way do my young children need to be vaccinated! Unfortunately Addy already had the 3-shot series, all before 1 year of age. Dori had one totally unnecessary one. I’ll consider completing the series for Dori around age 12. I do realize the disease can possibly slip through in a blood transfusion. But until she is much older, Dori’s immunization card will continue to say “refuses.”

That this one is universally given to newborns really irks me. I realize that’s to protect babies born to Hep B positive mothers, but I do not carry the disease and it makes me angry that Addy was subjected to the poke when she was just hours old. Anything that can interfere with getting breastfeeding off to a good start and isn’t absolutely necessary is just a bad idea. (That’s my own frustration, not one stated by Dr. Sears!)

Rotavirus

This is most serious in the first year of life and less trouble after 2 years old. Dori is almost 2, there’s no reason to get it now. It’s new, so Addy did not get it, and it does not appear on Dori’s immunization record either. I might consider it for a new baby starting at 2 months because it is a common disease most babies catch even if it isn’t diagnosed, although not being in day care will lessen the risk (transmitted by stool and saliva). Breastfeeding also decreases the risk.

Concerns me about the vaccine

• I might consider contributing to the herd effect, but the vaccination is intended to cause a mild infection.

Polio

Because the U.S. has been free of polio since 1985, the girls will not finish the vaccinations as young children. Both received the initial 3-shot series, but will not get the typical 5-year-old booster yet. They will get that at around age 10 or later to contribute to the herd effect and help to keep the U.S. polio-free. I also anticipate they may travel internationally, and polio is active in Asia and Africa.

Makes me more comfortable about the vaccine

• Inactivated virus; can’t get disease from vaccination.
• One of safest vaccines as far as side effects go.

Concerns me about the vaccine

• Guillian-Barre Syndrome is a reported side effect, though more rare than with other vaccinations.

Measles, Mumps and Rubella (MMR)

Because the risk of a severe case of any of these diseases is nearly nil, Addy will not get the 5-year-old booster. She already had the first shot at 1 year. Dori has had none, so she will get a single dose for each disease if she is not already immune when older.

I will ask for titers around age 10 to check their immunity. If they’re not already immune, I’ll consider the vaccinations then. I may possibly get them separately (those who link MMR with autism recommend getting each a year apart; though not a big concern for me especially at an older age, it would not hurt). I’ll make sure their health is at its peak at the time and give vitamins A and C before and after the vaccinations. Rubella immunity is important since they are female (see more about rubella in pregnancy below). Measles and mumps are more serious in the teens and adulthood.

Measles is usually not serious and getting it now is rare.

Mumps is also usually not serious, though I might reconsider this for a baby boy where swollen testicles from the disease can lead to infertility. The mumps immunity wears off by adulthood anyway.

Rubella is a mild disease. I understand the need to protect pregnant women from getting it so their babies do not develop birth defects.

Makes me more comfortable about the vaccine

• Only one shot is needed if you wait until age 4 or later.

Concerns me about the vaccine

• Complications from the diseases are similar to the vaccine side effects.
• For children who do get serious measles, the risk of fatality is high at 1:1,000.
• While I don’t intend to jump to conclusions about vaccines and autism, that vaccine strains of the measles virus show up in the intestines and brains of children with autism is concerning. It’s not my reason for avoiding this vaccine, but it’s worth noting to me.
• Vaccine uses live viruses.
• Side effects are common — 1:20.
• Guillian-Barre is one.
• Even the package insert says encephalitis may be caused by the measles vaccine.

Chickenpox (Varicella)

Chickenpox is usually not a serious disease. Addy received the first vaccination at 1 year; Dori did not and will not. Addy will not receive the typical 5-year-old booster.

We hope the girls do get the chickenpox when they are young and otherwise healthy (though it would be good for Dori to be a little older so she can communicate discomfort to us). This would ensure better lifelong immunity than the vaccination. We know it can be dangerous for a baby inside the womb in the first half of pregnancy or with in several days of delivery when the mother has chickenpox.

We will ask for a titer when the girls are around 10 or 11 years old. If the blood test does not show immunity, we will vaccinate then. We’ll make sure their health is at its peak at the time and give vitamins A and C before and after.

I wonder just how much immunity Addy has with the one shot she received. I wonder if she had major exposure (such as at a chickenpox party) how likely she would be to catch it.

Makes me more comfortable about the vaccine

• Cases are down 75% since the vaccine was released.

Concerns me about the vaccine

• Whole, live virus can cause the disease.
• Most of the side effects of the vaccination are the same as the side effects of the disease.
• 4% get a rash about 2 weeks after the vaccine. Addy was one of them, with a rash 3 weeks after.
• For those who receive it, it probably only lasts into the teens.
• Guillian-Barre Syndrome is a reported side effect.
• Vaccinated children can still catch chickenpox, though it would likely be a milder case.

Hepatitis A

Because hepatitis A is harmless in kids and Michigan is not a high-rate state for the disease, Dori will not get this vaccine. It was only added to the American Academy of Pediatrics schedule in 2006.

Hepatitis A is common in underdeveloped countries. Addy and I received the two-shot series in 2004 before traveling to Belarus. Bob got the first shot. We’d reconsider the possibility of a severe case before traveling to an at-risk country with Dori.

The shots are given to promote the herd effect to protect adults around the vaccinated children. The disease can cause damage in a person where there is already underlying kidney disease. We may be willing to contribute to the herd effect to protect these people, but we will wait until Dori is around age 10 and first check for immunity with a titer.

Makes me more comfortable about the vaccine

• Inactivated virus; can’t get disease from vaccination.

Concerns me about the vaccine

• Seizures are a side effect, but are less common after age 2. No way would we consider this before that age unless necessary for travel.
• Guillian-Barre Syndrome is a reported side effect.
• Contains aluminum.

Influenza

My children will not get this vaccine.

More than 90% of flu deaths are in people age 65 and older. The vaccine is given to prevent its spread to the elderly and chronically ill. Children who are breastfed and at home are at lower risk.

If our life situation were to change and we spent more time in very close, regular contact with elderly people, I might consider the vaccine to protect them. I would not give it to a baby and only to a healthy child.

Makes me more comfortable about the vaccine

• Flu is common.

Concerns me about the vaccine

• There is a high rate of side effects.
• It’s available in a nasal spray or shot. The nasal spray is a live virus, which can cause the disease. It’s 50% more effective than the shot though.
• Guillian-Barre Syndrome is a reported side effect.
• Some brands and multi-dose bottles contain mercury. If we ever got it we would ask for a mercury-free brand and single-use vial by name.

Meningococcal

I might consider this when the girls are in their teens, specifically before going off to a college dorm. At this point I would not give it at age 12 as on the AAP schedule. In fact at this point it is so new I’m not sure what I would do if I had a teen now. I’m glad it will have been around awhile by the time my girls are older.

And, Guillian-Barre Syndrome is a reported side effect.

Human Papillomavirus (HPV)

A woman who abstains from sex before marriage and marries a man who does the same does not need this vaccine. I know, I know, I shouldn’t be so naïve. But, my 12-year-olds will not be getting this then. I will realistically consider their situations at that age and make decisions then. I realize there’s a risk of birth defects if the girl gets pregnant in the first month after getting the shot, so if given it should be before that is a possibility. Because it’s so new there isn’t a lot of safety data yet, I’m glad I have years before needing to decide about this one.

Other notes

• In short, Dori is done getting shots until age 5 and, once Addy gets the tetanus booster, she will be done until age 10.
• If or when the girls do get vaccinated, I will firmly rub the spot first to reduce pain.
• I will continue to breastfeed whichever of my children are current nurslings during shots to increase their comfort.
• If my children ever do get a “vaccine-preventable disease” or if I even suspect it, I promise to get treatment and quarantine them appropriately at home to avoid spreading it. As Dr. Sears says, “… don’t give her a fever reducer and send her off to school.”