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Monday, October 3, 2011

Rethinking childhood vaccines

If we all sat back and thought about what we're knowingly exposed to every day, combined with what we don't know that we're exposed to, it would probably make us never want to leave our houses again, instead happy to sit at home and bathe ourselves in a bleach solution. There are so many unknowns in life - things we are afraid of that never materialize, things we should be afraid of but aren't - that it's crazy to fathom it all.

While I do vaccinate my children, I am increasingly wary and weary of the mass hysteria surrounding vaccinations. Admittedly it can happen on both sides: the non-vaccinating crowd offers up just as many horror stories as the vaccinating crowd does. I don't agree with assumptions that 'no vaccine ever saved anyone,' nor can I stand the "If there's a vaccine or a pill out there to cure my XYZ, I'm going to take it!" I guess I stand firmly, skeptically, in the middle.

When my daughter was just eight weeks old, my old pediatrician practically begged with me - downright pleading - to at least consider the hepatitis B vaccine (which I had declined at the hospital). Knowing that I didn't meet any risk factors (and had already been vaccinated as a healthcare worker), I wanted to say no, because at the time my daughter was already in the throes of a nasty milk protein allergy that I wanted to get to the bottom of first. But my ped practically wouldn't let me leave the office. 

I declined the rotovirus, and she said, "Well, at least get the hepatitis B." It was almost like she was saying, "Just get one shot. Any shot. As long as you get something." 

This summer my daughter sat on the exam table at the peds office, the poop nearly scared out of her because she had to have the dreaded "shot!" She was missing four shots, one of which was my eternally non-favorite: the chicken pox vaccine.

The book (published,
ironically, around the same
time the vaccine came out)
says chicken pox is a
"normal childhood illness."
I'm surprised the CDC
hasn't lobbied hard to
take it off the shelves. 
My daughter, being almost five, was - according to my research - the prime age for when chicken pox usually happens. I asked, almost facetiously, "Don't you think that if she was going to get it, she would have had it by now?"

"Oh nooooo," The Pretend Doctor stated, rather dramatically. "Because then if they get them as adults they're much worse and they can end up in the hospital." (insert horrified expression here)

I wanted to blurt out hysterically, "Are you kidding me? That's your idea of informed consent?" I thought back to the information I'd looked up on chicken pox and the shingles, and also to those people who I had actually known in my life that had shingles: all three of them. One was going through the obvious stress of the death of her son, and even in her pain (both physical and emotional), seemed to be pulling it together. The other guy is just a stress ball as it is, and I think the third person likes to really play up how miserable she is/was/will be whenever something wrong is going on.

None of these people, in my estimation, ever had to go to the hospital. And I'm pretty sure none of them are dead.

While it's true that chicken pox can be quite ugly if you get it as an adult, I question how the chicken pox vaccination is going to remedy that. I don't know if anyone can conclusively say how long the shot's immunity is supposed to last, and even when given a booster shot, that pretty much means they'll be fully exposed to potential illness around the time they reach adulthood. But...what? That means they'll stand to get it when it's more prone to cause complications, right? How can that be?

But wait - you can get another booster shot as an older teen or adult. Or you can just get the wild virus as any kid prior to 1995 would have done and be done with it, resulting in (for most) lifelong immunity.

Aside from the short-term costs of missed work days (assuming there are some), the cost of acquiring lifelong immunity the good old fashioned way (assuming you were a normally healthy kid) is pretty inexpensive. The cost of the vaccine (anywhere from $80 to $120, depending on where you live, multiplied by the number of boosters you receive) is not.

And like other vaccines, even if you get the shots, you might still get the chicken pox. These children in Michigan experienced an outbreak despite the vaccine, which has many wondering if it's a new mutated strain taking hold.

There are also some who believe the chicken pox vaccine is creating significantly more cases of shingles in adults, because their natural exposure to the wild virus is severely curtailed - whereas before it was actually an immunity booster.

My problem with the chicken pox vaccine started, however, when my oldest was around a year old. I had never done much research on it, but at the time, it didn't make much sense to vaccinate a child for what was perceived as a "normal childhood illness." As I raised questions, the nurse - holding my son's arm, needle poised - basically said, "Too late now," and proceeded to inject him. (I think this was after a brief "He won't be able to go to school if he doesn't get this," spiel.) Looking back on it now, why the hell would anyone proceed if it's obvious the parent is not completely on board with the idea? Put down your needle and say, "I think you should talk to the doctor about this and we'll vaccinate him when you've made your final decision." Not say, "Too bad for you. We're doing it anyway. Just get the damned shot."

That's the idea about some vaccinations that doesn't sit well with me. Unfortunately, when people start to ask questions others in the "Let's Vaccinate Everyone!" camp cry foul and start pouring on the sob stories, making you feel like a (stupid) bad parent that doesn't know anything, whose opinion can be swayed with the blowing of the wind. Well, I have news for you - vaccinating your kid for everything, all the time, might not be such a hot idea, either.

It struck me not long ago that the primary motivation behind the chicken pox vaccine was not so much to save the 100 or so kids who die yearly from chicken pox complications - it was to prevent lost sick time because fewer households include a stay-at-home parent. You can't prevent every illness, and will sacrifice lost work time for a variety of reasons throughout their childhood. The face of parenthood has changed in the last 30 years or so, with more kids in daycare, fewer stay-at-home parents and lower breastfeeding rates, which means vaccine manufacturers stand to gain a lot of money off of people who want their children to get sick as few times as possible, so as to prevent any disruptions in routine. I guess I can agree with that, but to a point.

But the first knee-jerk reaction is to lay blame on the parents, as this mother did, because her leukemia-stricken son couldn't attend daycare since at least one child was unvaccinated. This is basically failing to admit that no vaccination is 100 percent effective, and really - when you're dealing with the unique and individual immune system it's kind of a crap shoot. The mother has no idea why that child isn't vaccinated, or what he's not vaccinated for - could he have an allergy to something in the vaccine? Did he have a previous bad reaction? And really, considering her son's potentially dire condition, why is she putting him in a daycare situation anyway?

The bottom line is that we are vaccinating children for something that is merely an 'inconvenience' to parents. At what point do you draw the line? We now have an entire generation of parents who think chicken pox is some horrible 'disease.' Seriously?!

When we look at the reported number of deaths from chickenpox, there is probably a lot more going on behind the scenes than people will admit. Can there be complications? Apparently so - but what they aren't telling us is why. Are these children immunosuppressed? Do they have other underlying illnesses?

As far as the effectiveness of vaccines, that's another one that's up for debate. It's not known, for instance, how long immunity from a polio vaccine lasts, yet people say that if we don't vaccinate, "millions of children" will be subjected to potential antigens within a year. Yet, if you read a little on smallpox from the CDC, we stopped vaccinating for it in the late 1970s because it had effectively been eradicated. But wait. I thought polio had been eradicated from the US as well. So why are we still vaccinating for that, but aren't for smallpox?

Interestingly enough, I recently read that then Vice President Dick Cheney wanted to start vaccinating for smallpox again because he was worried that bioterrorists would get their hands on it and turn the virus loose on the population. President Bush said no, because he was worried that people would die from just being vaccinated. (Approximately 1-2 % of people die from the vaccine.) Finally, someone who is willing to admit that vaccines can carry some risks, potentially death. And yet, when sporadic cases of Guillain-Barre syndrome show up in the population after flu vaccines are administered, as they have been doing since probably the 1970s, the industry is unwilling to admit there is a link and basically shrugs it off.

A few years ago there was hushed talk about a pertussis outbreak going around. Stupidly, I didn't think much to ask about it because "hey, my kids have been vaccinated for that!" One of my husband's students - who was previously unvaccinated - ended up getting it and the campus was in an uproar. The nurse went off about how his wacko parents were against vaccinations and were giving him daily "vitamin injections" or something or other, and at first I was upset, too. Until I realized that even if he had initially been vaccinated, it wouldn't have mattered, because it likely would have worn off on him by that time. As a result, that kid now has, researchers believe, lifelong immunity - instead of potential gaps in his immunity from the vaccine.

One of the biggest things that make me question vaccines are the outrageous marketing campaigns waged on us by healthcare professionals and the pharmaceutical industry. Overly dramatic ads run constantly; even Jennifer Lopez is in on the act. (I picture someone off-camera saying, "Now use your saddest, most dramatic face!") With that kind of melodrama it has to make you wonder about their motives, most of which include a lot of dollar signs - you can't help but notice the great financial rewards drug manufacturers stand to gain from developing these vaccines.

A nauseating billboard down the street from my house 
When it comes to informed consent about what we're giving our children, it needs to be more than just "Vaccines are safe! Vaccines are necessary!" Understanding how diseases work and why is tricky enough, and it doesn't help when your doctor doesn't even fully understand the implications of having such a vaccinated population - and how there can be drawbacks to seeing otherwise normal illness as a serious event. Our philosophy on illness has changed so radically as to seek to prevent nearly every little sneeze or sniffle with a pill or injection, which can have many negative repercussions, including the idea that "Because I agree to accept the potential risks of doing this, you need to do the same."

It seems like when there are perfectly good low-cost, natural remedies available, they are passed over in favor of vaccinating or taking more pills. In combatting the seasonal flu, covering your coughs and sneezes, as well as washing your hands, is often one of the best, easiest and cheapest ways to avoid getting sick; you can't deny that. Eating healthy, taking vitamins and getting enough sleep are also important to staying healthy, but our Pill Generation increasingly ignores these guidelines in favor of some injection or other to prevent this and that. In a probably not-so-new twist, drug companies are turning to legislators (Gardasil mandates) to essentially force, or at the very least coerce, you to use their product - especially in the face of  declining profits - instead of promoting ways to lower your risk factors.  (Like washing your hands and covering your cough will work for flu, there are perfectly plausible ways to lower your risk of getting HPV - that not too many people want to talk about).

As they say, "An ounce of prevention is worth a pound of cure."

Dramatic ad encouraging parents and children to be vaccinated for whooping cough


Jen said...

Great post!!! And this is why none of us in our family get our flu shots now! And guess what? We haven't been sick with the flu since! *knocks on wood for good measure* :)

The Deranged Housewife said...

The flu post is next LOL. This one issue brings up a number of others, including my last post on the Gardasil vaccine.

Angie in PA said...

I *so* completely agree with you on this. My kids are 'partly' vaxed. we looked at the CDCs description of each disease, looked at the occurance rates and the hospitilization/death rates from getting the disease vs the hospilization/death rates of getting the vaccine and made our decisions from there. We delayed some vax, we have declined some altogether and will vax when our kids reach adolescence if they don't aquire natural immunity on others. It's complicated, but we are being INTENTIONAL in our decisions... Nice, balanced post!!

Kate said...

Something else about the pertusis vaccine- the big 'outbreaks that occur are largely usually in a vaccinated population.

Erin Whitney said...

Such a good post. After a reaction to the MMR vaccine when our son was 12 months old, we decided for our family it was best to no longer vaccinate at this time. The one year I did get the flu shot (scary doctor said I could kill my baby if I got the flu...yikes) I had the worst flu ever. For 2 weeks. Our son got it, too. Makes you wonder. I'm due with baby #2 in January, and while I'm not planning on vaccinating at this time, I still do research. And my son has that Arthur book on chicken pox and keeps asking when he'll get them. Is it crazy we're looking for a "chicken pox party"??

TracyKM said...

This is exactly what so many parents are thinking!

When my kids had chicken pox, I posted on Freecycle that I was offering the virus. One mother was outraged. Her daughter caught CP at 15 months, before the standard vax time back then, and had severe complications (almost blind, one kidney non working, etc). I feel for her, but how does she know the vaccine wouldn't have caused injury too?
I was surprised to hear Dr Sears say on "The Doctors" that ONE CP vax is enough. Ontario just added a booster to the free list, and has now combined MMR with varicella!
The issue with the polio vaccine is that polio is still VERY common in some countries, and those countries have a lot of emigrants who end up in our countries. I'm not keen on it and I'd like to think our risk is low---but there are a lot of immigrants in our community.
Pertussis can be deadly to infants, and is most often spread by adults whose immunity has worn kids are RARELY around babies, so I'm not worried about it. As my kids age I am worried about MMR and meningitis. However, I've heard it's impossible to get the MMR broken up in Ontario, but maybe now it's also combined with varicella they will start offering the separate components for those that don't need varicella.
I have heard that Prevnar is one of those shots that isn't really needed--the amount of protection is quite low compared to the number of virus that cause those illness, and those viruses are mutating now BECAUSE of the vaccine.

The Deranged Housewife said...

Tracey, I did see that - how they are combining the varicella with the MMR. Ridiculous. I agree that some of these are needed, but honestly l- what would it take to stagger the doses and boosters and not give a million different things at once? I honestly think the only way they can remain so ambigious about vaccine injury is because there are several ingredients in each and it's hard to pinpoint which one caused a reaction.

Other points you made echo my sentiments - and are some that I will probably get to in future posts - that we are tampering with a bigger picture here that could pose serious health risks to us as a whole. Just look the overuse of antibacterial soaps, for one. As far as endemic illnesses from other countries ending up here - yes, that is true; but I'm curious if we can avoid disease by having more immigrants go through proper, legal, channels to get here. That is one of the possible serious consequences to illegal immigration, honestly - if we have people coming here and managing to live here who have come from areas where previously eradicated diseases are endemic, it could pose problems even for the vaccinated community. After all, those shots aren't 100 percent guaranteed.

I even question the use of MMR in the sense that mumps, really, is not 'dangerous' and there is nothing life-threatening about it. So why include it in the shot? It's one of those 'convenience vaccines' much like chicken pox, I think. You have to wonder, though, why we're so worried about certain things - what about diseases that are far more lethal? Anthrax? Ebola? Hanta virus? Which can be carried by field mice, and considering how the majority of homeowners don't even realize their house has mice - I'd be way more scared of that!

Myndee said...

We have a chicken pox book too. "itchy itchy chicken pox", and it's true- it makes the virus seem run of the mill. 5th's disease and Hand, Foot, and Mouth will become scary once there is a vaccine for them. ;)

The Deranged Housewife said...

Myndee, I agree - "Fifth's DISEASE!" It's a disease, let's panic! :?

Anonymous said...

I selectively vaccinate but also realize there may be consequences.
My nephew spent weeks in hospital and was medivaced 500 miles from home to treat a massive group a steep infection in his leg secondary to chicken pox. My niece was hospitalized and put on a respirator when she contracted pertussis at 3 months old. I have had two children admitted for dehydration acidosis secondary to rotovirus. Every single one of these children were normal healthy children with good nutrition and hygiene. Choose what you think is right for you family but do not become complacent about the VPD thinking that well nourished western children won't have any morbidity or mortality. I think too many families that choose not to vaccinate expend all their energy on learning the cons of vaccines but not enough on the s&s of the diseases they prevent and possible long term consequences like male sterility from mumps.

Alli said...

very good wariness of vaccines started when they first started the German Measles (MMR i believe) vaccine. They vaccinated all Grade 5 students in the schools in our area. I had an allergic reaction to something in the vaccine....went unconscious and starting vomiting. My father who NEVER left work for anything had to come pick me up from school.

I refused to have my grade 7&8 vaccines after that. However in high school I finally did some research and decided to get the tetanus shot in Grade 12 because the risks of the disease outway the risks of the vaccine - IMO.

Both my husband and I think that selected vaccines are the best option for us and our family.

The Deranged Housewife said...

I had a tetanus shot - after I bashed my hand through a glass window accidentally. I'm not sure if prior to that I'd had one in conjunction with another vaccine, but I was always under the impression that if you hurt yourself badly enough, under certain circumstances you should get a tetanus shot. Not get one as a matter of course.

As far as mumps, they can render adult males infertile, but apparently this is a very rare complication. And once you've had them, you're immune. How many adult men walking around now are thinking they're immune when they're really not? I know my MMR wore off by the time I became pregnant, and it was only a matter of chance that I happened to be revaccinated before I had my first child.

Anonymous said...

I have two children who are up to date on most of thier vaccines. I agree that doctors will send us in the wrong direction if we don't do the research ourselves. It really comes down to finiding a pediatrician that you can trust, one that understands your feelings and doesn't have some hidden agenda to put extra money in his pocket or some drug companies. My doctor advised against the chicken pox vaccine for atleast a few years. He believed that it's an unessecary drug. I tell all my friends that one of the most important things to do while pregnant is find an amazing pediatrician who will allow you to parent in your own way with out judgement.

Helen said...

I just wanted to respond to this: "But wait. I thought polio had been eradicated from the US as well. So why are we still vaccinating for that, but aren't for smallpox?"

Firstly, we are now in 2012 and people travel internationally FAR more than they did when small pox was eliminated from the US. Polio still exists in a few pockets of the world and could easily make it to the US. Secondly, polio is asymptomatic in more than 99% of infections and therefore can spread silently through a population for a long time or over a long distance before the tell-tale paralysis pops up in a child. In contrast, small pox was very readily identifiable meaning that you could see it and jump on it quickly, isolating the child, vaccinating everyone in the surrounding area etc. Thus we have to be FAR more wary about polio transmission than we did about small-pox transmission. Thirdly, the small-pox vaccine was highly efficacious with just one shot so if a child had a record of having the vaccine, you could be pretty sure they were protected and safe to travel. In contrast, the polio vaccine used in the countries that still have polio (the oral vaccine) has very low efficacy so a child could have had several shots but not be protected.

And from my second point, they could be infectious but asymptomatic and from my first point they could be more likely to get on a plane to the US than kids were back when small-pox was around.

These are the reasons why polio vaccination will remain necessary in every country until it is eradicated worldwide.

The Deranged Housewife said...

In countries where the oral vaccine is being given, you have cases of polio caused by the vaccine. It's a tradeoff, because access to clean water facilities is probably not going to happen anytime soon, therefore they feel the risks of getting polio from the vaccine are less than contracting it from a water source. Hmm....

Also, did you know that in some people, the smallpox vaccine will kill them? During the Bush administration, Dick Cheney wanted everyone to be vaccinated for small pox again because of bioterrorism threats, but George Bush said know because of the (albeit small) chance of death that vaccinating can bring on the population.

Helen said...

Yes I did know that the smallpox vaccine can kill and that that is precisely why mass vaccination was decided against - the risk posed by the vaccine outweighed the risk of an actual smallpox bioterrorist attack.

And yes the oral polio vaccine can cause polio. More specifically, the oral vaccine can cause paralysis in the recipient (estimates of risk vary but around 1 in 750,000 for the first dose and much less for subsequent). Additionally, the vaccine virus can - in rare circumstances - mutate and cause what is known as a vaccine-derived virus which is as virulent as wild poliovirus and can be transmitted. Ironically, the best way to eradicate these viruses is by fully immunising the population as this provides protection. Yes, the risk of paralysis caused by the oral vaccine is less in certain countries than that posed by infection via water sources (and other means of fecal-oral transmission). Despite it's short-comings, the oral vaccine is the only way to eradicate the disease for several reasons including: cost, ease of administration, ability to provide mucosal immunity (which the inactivated vaccine doesn't really have in developing settings thus not preventing infection and transmission like the oral vaccine does) and secondary transmission of the oral vaccine conferring immunity to some children who haven't received the vaccine.