Healthy Living: A Shot or Not

 

It’s not a choice. If you live in Connecticut and you want your kids to go to school, childhood vaccines are mandated. And you better believe the vaccine schedule from birth to age 6—as laid out by the federal government’s Centers for Disease Control (CDC)—is a full dance card. There’s HepB, given in three doses between birth and 18 months, designed to prevent the liver infection Hepatitis B; four doses of PCV between 2 and 15 months, to guard against bacterial pneumonia; DTaP in five doses between 2 months and 6 years, for diptheria, whooping cough and tetanus; two doses of MMR (measles, mumps, rubella), four doses of Hib (Haemophilus influenzae, which can cause meningitis), four of IPV (polio) . . . in short, if your pediatrician follows CDC recommendations to the letter, your child can expect up to roughly three dozen vaccines as protection against 14 different communicable diseases that, in generations past, often led to hospitalization, disability and sometimes death.

Baby-boomer grandparents who remember that sucking on a sugar-cube dosed with polio vaccine was once considered the greatest triumph of science next to the 1969 moon landing would be astonished by the regimen young parents are now expected to keep in their infant’s first 18 months. This includes several doctor’s office visits requiring as many as five or six shots each. Still, that’s all to the good, right? After all, mass vaccination campaigns have eradicated smallpox and nearly eradicated polio—a fearsome crippler and killer of young children in the first half of the 20th century—in our lifetimes, while keeping other viral and bacterial threats from blossoming into epidemics.

Alas, these days it seems there’s little joy in Wellville. Along with all of our public-health successes has come fear, particularly of the side effects and allergic reactions some vaccines can produce. While these are limited mostly to swelling at the injection site, fever and/or mild physical discomfort, on rare occasions (one in 100,000) something more serious happens—seizures, for example. Such events have led to loud calls from the populace for greater “safety.” But safety is a relative concept, says Dr. Steven Novella, assistant professor of neurology at Yale School of Medicine and senior editor of the blog Science-Based Medicine. “Certainly, not all vaccines are equally safe,” he says. “But all vaccines that are currently administered have greater benefits than risks to the individual. That’s the bar that we set before we allow vaccines on the market and recommend them for use, whether for routine prevention or targeted populations.”

Two of the greatest vaccine fears include the potential side effects of certain additives, the main one being aluminum hydroxide, used as an adjuvant to improve the efficacy of many vaccines (although research indicates that babies get more aluminum in their daily formula), and the possibility of “vaccine overload” overwhelming an infant’s immune system. Jeffrey S. Gerber and Paul A. Offit—of the Children’s Hospital of Philadelphia’s Division of Infectious Diseases—debunked the latter in a 2009 article in the journal Clinical Infectious Diseases, pointing out that infants’ immune systems can, and do, respond to thousands of pathogenic threats simultaneously. In addition, improvements in vaccine design in recent years have actually lightened the immunologic load, so that the number of active components in 14 vaccines is actually less than 10 percent of the components present in the seven vaccines given in 1980.

A far greater worry to the medical community is the way such fears can disrupt vaccine compliance, particularly when immunization numbers drop to the point that they threaten “herd immunity”—the delicate balance that’s achieved when the percentage of the vaccinated population in a community is high enough to protect those with immune deficiencies (or other relevant health problems) from a disease outbreak. This  percentage varies from disease to disease depending on how contagious it is; for instance, for a community to achieve herd immunity from the measles, vaccination rates must top 90 percent. Connecticut, it should be noted, has a virtuously high rate of vaccine compliance: For the last 15 years, the state has ranked in the top five states for on-time childhood immunizations—and in 2008, CDC officials visited Hartford for a congratulatory ceremony. This performance has been enhanced by our adoption in 1998 of a system for all newborns called the Connecticut Immunization Registry and Tracking System (CIRTS).

Other parts of the world have not fared as well. The reason polio has not yet been eradicated—though it’s no longer endemic in the United States—is a failed vaccination campaign in northern Nigeria early in the last decade. “At the time, Muslim clerics started spreading a scare about the vaccine, saying that it was a conspiracy by Western medicine to spread polio and AIDS,” Novella says. By 2006, Nigeria was determined to be the source of over half of all new polio cases worldwide.

 

Developed nations are not immune to such scares or their consequences: Witness the much publicized follies of British gastroenterologist Andrew Wakefield. In 1998, he and several colleagues published a paper in the medical journal The Lancet suggesting a link between the MMR vaccine, inflammatory bowel disease and autism. Though none of this was proven, in a press conference Wakefield recklessly asserted that MMR vaccinations should be stopped until more research could be done, adding that it was a “moral issue.” As a result, MMR vaccination rates plummeted from over 90 percent to under 70 percent in certain parts of Great Britain, and reported measles cases rose from 56 in England and Wales in 1998 to 1,370 in 2008.

Causal connections to autism have also been claimed for the preservative thimerosal, an organomercury compound used to prevent contamination in certain vaccines since the 1930s. Fueled by concerns over potential (though not established) toxicity, in 1999 the federal government began a precautionary campaign to phase out its use (it’s still found in the influenza vaccine, although children age 3 and under are given a thimerosal-free equivalent). However, in 2003, respected environmentalist Robert F. Kennedy opened a new Pandora’s box with his article, “Deadly Immunity,” published both in Rolling Stone and on Salon.com, which charged that the CDC had conspired to cover up the dangers of thimerosal to protect the pharmaceutical industry.

By 2011, both Wakefield’s and Kennedy’s theses had been roundly discredited, largely because innumerable scientific research studies found no proof that either thimerosal or the MMR contribute to the development of autism. Significant misinformation and misrepresentation in Kennedy’s piece (examined most recently in Seth Mnookin’s social history The Panic Virus) led to its removal from both Rolling Stone’s and Salon’s websites.

As for Wakefield, a series of investigative articles in the Sunday Times of London charged that the doctor was guilty of fraudulent data manipulation, financial conflict of interest and mistreatment of his research subjects. Struck off the medical register in Great Britain, his paper retracted by The Lancet, in January of this year he could be seen trying to defend his honor in uncomfortable showdowns on CNN’s “Anderson Cooper 360°” and ABC’s “Good Morning America.”

Still, disreputable as they are, these particular vaccine controversies have sparked a panic that’s proven hard to stamp out. Vaccine paranoia has been with us ever since Edward Jenner, the 18th-century “father of immunology,” stuck cowpox pus in milkmaids’ arms to defeat smallpox and was caricatured as the guy who would turn all his patients into barnyard animals as a result. But at least Jenner didn’t have to contend with the Internet and television.

Thanks to websites like Age of Autism and Generation Rescue—a key platform for autism activist Jenny McCarthy—not to mention ongoing opportunities in recent years for Wakefield, McCarthy and their sympathetic peers to appear on talk shows such as “Oprah” and “Larry King Live,” the notion that vaccines must be to blame for autism has been able to gather considerable momentum before science has had the chance to fully explore other hypotheses.The fact that autism is considered epidemic by many—boasting a current prevalence of one in 110 children—has only fed the anxiety.

In a 2010 University of Michigan study surveying 1,550 respondents, researchers found that although 90 percent of parents believed vaccines were a good way to protect their children from disease, one in five were still concerned that the autism link might be real, leading study director Gary L. Freed to note, “It appears current public-health education efforts on this issue have not yet satisfied many parents’ concerns.” Meanwhile, a number of parents have reported seeing vaccine-related autism develop in their own children—one being Trumbull’s Kim Stagliano, managing editor of the blog Age of Autism.

Stagliano has three daughters on the autism spectrum: Mia, 16, Gianna, 14 and Bella, 10. Her two older daughters received their childhood vaccines on schedule, then at a later date, she says, began to show the classic problems of language and social development associated with autism. They were both diagnosed at the end of 1999. While pregnant with Bella, she read a magazine article about mercury in vaccines. “Before that, it didn’t even occur to me that I should question,” she says. “Vaccinating my daughters was like breathing. The article just sounded wrong. Who puts mercury in a baby? I wouldn’t­—and yet I had.” (Bella remains unvaccinated; Stagliano attributes her diagnosis to a mishandled breach birth.)

Novella points out that parents of children with autism will often “recall” that the child’s problems started right after a particular vaccine or series of them, when in fact the records­—if they’re available—show that the appearance of the autism symptoms did not coincide with the vaccine schedule. (For example, while the MMR is administered at 12 months, signs of autism often show up as much as six months earlier.) “It’s not that the parent is lying; it’s just that that’s how human memory works,” he says. He understands why parents would latch onto this explanation. “Science has identified quite a number of genes that contribute to autism, and we’re starting to unravel what’s going on in the brain. But there’s still a lot of uncertainty, and parents are desperate.”

 

This uncertainty has led to an increasingly pitched battle within the autism community itself—those who blame vaccines versus those who believe the focus on vaccines has led to a counterproductive “hijacking” of autism research. In the latter camp is Michael J. Carley, executive director of  the Global and Regional Aspberger Syndrome Partnership (GRASP), who was diagnosed with Aspberger’s at 36 in 2001, the same day as his then 4-year-old son. Not only does he believe autism is “primarily genetic,” he says, “Even if all this nonsense about vaccines were true, the language that’s being used leaves GRASP’s audience feeling as though we’re all chemical accidents. And it signifies a belief on the part of these parents that their real child is not the one who’s before them—that they have to find a way to ‘cure’ that child.”

Stagliano outright rejects the genetics argument, laughing off a study, published in the journal Pediatrics, which suggested that having babies close together in time might increase the risk of autism (“I mean, what about twins? Are you kidding me?”), and is not alarmed by the fact that measles outbreaks in the U.S. are occurring more frequently, fueled by parents fear of giving their children the MMR (“The Brady Bunch had measles—I’ll take measles any day of the week over autism”).

What she’d like to see is a research study that would compare groups of unvaccinated children to vaccinated ones, to see which group develops more cases of autism. “I bet a lot of parents would volunteer for that,” she says, unconcerned that what she’s proposing violates at least one principle of reputable scientific research—that subject groups must be randomized, not to mention that a study structured to deny a large population of people protection from potentially deadly diseases would be unethical. “It’s also not ethical to mandate vaccines when the question isn’t answered as to whether they’re safe for your individual child,” she counters.

Some worry that this kind of vaccine paranoia has become so immune to reason and scientific data that it’s almost a religion. Seth Kalichman, assistant professor of psychology at the University of Connecticut in Storrs and author of Denying AIDS: Conspiracy Theories, Pseudoscience and Human Tragedy, sees it as another form of “denialism”—much like global warming, Holocaust and evolution denial—fueled by junk science, conspiracy theories and pseudoexperts, as well as an antiauthoritarian refutation of true experts (Age of Autism, which is notably filled with ad hominem attacks on vaccine experts and advocates like the Children’s Hospital of Philadelphia’s Paul Offit and impassioned defenses of Wakefield, certainly seems to fit the bill). “I think it’s a mental-health issue,” he says. “Certainly, dealing with autism is incredibly devastating—I’ve worked with some of these families—and faced with the responsibility and uncertainty of it all, anyone would experience denial. But what we’re seeing here is a perpetual state of denial.”

Connecticut doctors in the trenches are well-accustomed to dealing with patient anxiety over the “individual” safety of vaccines. One strategy some of them use with parents concerned about “vaccine overload” is to follow a lengthier alternative schedule to the CDC protocol, as laid out by Southern California pediatrician Bob Sears in his compendium The Vaccine Book: Making the Right Decision for Your Child. While researchers have pointed out that there’s no advantage to Sears’ schedule—“All it does is leave children susceptible to infectious disease for longer periods of time,” says Novella—and it requires a greater number of doctor visits to complete, East Hartford pediatrician Larry Scherzer finds it useful in winning patients’ trust. “To me, the issue is getting the vaccines done,” he says. “If that means parents want to come in every month, that’s fine with me.”

Efforts to improve  and monitor vaccines are being made all the time. Eric Secor, a naturopathic doctor and research fellow at the UConn Health Center in Farmington’s Center for Integrative Immunology and Vaccine Research, is currently looking at the potential of bromelain—a pineapple enzyme often used as a natural anti-inflammatory—as an effective adjuvant. “One of the controversies surrounding vaccines is whether the adjuvants we use, like aluminum hydroxide, predispose people to asthma,” he says. “Certain botanical products might work as effectively without producing worrisome side effects.”

Meanwhile, Yale School of Medicine’s Eugene Shapiro, professor of pediatrics, epidemiology and investigative medicine, and Marietta Vazquez, assistant professor of pediatrics, have focused on evaluating the effectiveness of vaccines in clinical practice. One ongoing area of research concerns the varicella, or chicken pox vaccine; recently, they published a study in the Journal of Infectious Diseases demonstrating that two doses, as currently recommended by the CDC, really are better than one. “While the first dose is  85 percent effective, later on vaccinated children may still experience outbreaks—which, while mild, can spread the disease,” says Shapiro. “The two-dose regimen raises the efficacy of the vaccine to 98 percent.”

As our vaccination options grow, even vaccine proponents wonder if we aren’t going too far. Waterbury pediatrician Diane Fountas suggests that, perhaps, the drive to vaccinate has become more a matter of “business” than care. Hers is “a ‘must-vaccinate’ office,” she says, that gives no quarter to the paranoia surrounding the MMR or influenza vaccines, but she admits she questions certain newer vaccine recommendations by the CDC—particularly the one concerning the double-shot of varicella (her practice has participated in Shapiro’s and Vazquez’s research). What particularly concerns her is the development of shingles she’s noticed—a consequence of chicken pox more often seen in later life—in a couple of her young, two-dose varicella recipients.

“I believe that vaccines are one of the few things in medicine that have made a difference in people’s lives,” she says. “But to me, the reason to vaccinate is to prevent permanent disability and death. Chicken pox is a nuisance illness, and the single shot seems to be eradicating the toughest aspects of it. I think medicine sometimes gets carried away with ‘good’ initiatives, until it becomes apparent we have to pull back. It’s like antibiotics: They’re truly wonderful, but overuse of them is not good for your body. There’s no question in my mind that vaccines are safe. But are they always what’s best for someone?”

Healthy Living: A Shot or Not

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