The Immunization Decision

Few would have questioned the merits of vaccinating children during the decades when major childhood diseases like polio ran rampant in the U.S., but parents sometimes wonder why it's necessary to have their children vaccinated against those types of diseases today. After all, haven't many of the diseases that American children are vaccinated against been all but eradicated in the U.S.?

Necessity or overkill? An American baby can expect to receive 11 immunizations and as many as 20 shots by age 2. The rationale for continuing with a mass vaccination program is simple: The viruses and bacteria that cause these diseases still exist and can be passed along to people who have not been vaccinated, potentially leading to severe illness and even death.

"Although these diseases are not very common in the U.S., they are common in other parts

of the world," explains Lynnette Mazur, MD, a professor of pediatrics at the University of Texas Medical School in Houston. "With international travel and immigration, there is a continued need to keep up-to-date with vaccines."

Joseph Simon, MD, a pediatrician with Children's Healthcare in Atlanta, agrees: "If the U.S. permitted its vaccination rate for polio to fall, our population would be only one plane ride away from an outbreak that would paralyze hundreds, and possibly thousands, of children before it was contained."

Weighing the evidence. But what about the supposed risks posed by the current generation of vaccines? That's one item you can scratch off your worry list right away, insists Ari Brown, MD, an Austin, Texas, pediatrician and coauthor of Baby 411: Clear Answers and Smart Advice for Your Baby's First Year (Windsor Peak Press, 20-03)."Vaccines are safe," Brown stresses. "They are tested and retested. There's an elaborate system of checks and balances in place."

Still, you're well within your rights to ask the tough questions and to insist that they be answered to your satisfaction before you agree to have your child immunized, insists Mary Bidgood-Wilson, a certified nurse-midwife and family nurse practitioner in Center Harbor, New Hampshire. "I don't think healthcare providers necessarily spend enough time talking to patients about immunizations."

Finding objective, balanced information about vaccines can be a major challenge, adds Washington, D.C., certified nurse-midwife Mairi Breen Rothman. "When I went looking for this type of information when I was trying to make up my mind about vaccinating my own four kids, it seemed to me that a lot of the pro-vaccine materials seemed to be put out and paid for by the vaccine manufacturers, whereas a lot of the anti-vaccine materials seemed to be put out by groups who weren't basing their research on solid science." She eventually chose to have her children immunized with almost all of the recommended vaccines. Rothman advises parents to talk to their healthcare provider and ask questions about this and any other medical decision they need to make for their baby.

MMR and Austism: is there a link? Speaking of asking the tough questions, what about the news stories pointing to a possible link between the measles-mumps-rubella (MMR) vaccine and a developmental disorder known as autism? According to the experts, there's no hard evidence to back those claims. The confusion seems to stem from autism tending to be diagnosed at around the same time that the MMR vaccine is typically administered, explains Melanie Koehler, MD, a pediatrician at Temple University Children's Medical Center in Philadelphia. Exhaustive research by the American Academy of Pediatrics, the Institute of Medicine, and the Centers for Disease Control and Prevention has failed to reveal any link between the vaccine and autism.

There was also some concern a few years back about a possible link between thimerosal (an organic mercury-based preservative used in certain vaccines) and the onset of certain types of neurodevelopmental disorders, although autism was never one of the neurodevelopmental disorders involved.

To be on the safe side, vaccine manufacturers have responded to concerns about the possible health effects of thimerosal on young children. According to Jay M. Lieberman, MD, a specialist in pediatric infectious diseases at Miller Children's Hospital in Long Beach, California, none of the vaccines that are routinely given to young infants in the U.S. today contain mercury. Note: Some influenza vaccines still contain trace amounts of mercury. Ask for a mercury-free version of the vaccine next flu season.

Vaccine reactions: what's normal, what's not? When it comes to vaccine safety, your primary concern should be your child experiencing a reaction to the vaccine. According to Simon, the most common reactions include fever, irritability, and redness or soreness at the immunization site. Because the list of signs and symptoms vary slightly by age of the infant and the type of immunization, ask your healthcare provider for guidelines on what to expect in terms of a reaction, and if necessary, call her if you notice anything worrisome or out of the ordinary.

"As a general rule, the side effects from a vaccine should abate with a dose of acetaminophen or ibuprofen," says Simon. "If the infant does not 'perk up,' smile, and play at least briefly after a dose of one of these medications, or if a high fever develops, then the healthcare provider should be contacted."

If your child develops a fever following his or her immunization, try not to get too hung up on how much the medication does or does not bring down the fever. Unless her temperature is sky-high, your baby's reaction and mood are much more important indicators of how well she is doing than the actual number on the thermometer, says Simon.

Fortunately, severe reactions tend to be extremely rare. "I can't think of the last time I got called about a child with a severe reaction to a vaccine," says Koehler.

What if my baby is sick? Wondering if it's okay to keep your well-baby checkup if your child wakes up with a runny nose and a low-grade fever on the day that he's due for his shots? In most cases, it's perfectly safe to immunize an infant with a mild illness, but this is a call your baby's healthcare provider will have to make, taking into account such factors as the type of illness and your baby's past medical history. "Although it is generally safe to immunize an infant who has a virus and a low-grade fever, if a particular infant has shown a tendency to high fever with illness, it might be prudent to not risk elevating that fever even further with an immunization," explains Simon.

It's also best to avoid having your child immunized if he's moderately or seriously ill, adds Lieberman. "Children might not respond as well to the vaccine if they are fighting off an infection. We also don't want the progression of the illness to be confused with a possible reaction to the vaccine."

Still, wherever possible, healthcare providers prefer to seize the moment and give a baby his immunizations on schedule rather than postponing that round of shots. "Deferring immunization...frequently results in unimmunized or inadequately immunized children who may develop or transmit vaccine-preventable diseases," explains Mazur.

When not to vaccinate. There are legitimate reasons for postponing your child's immunization or possibly avoiding a particular vaccine altogether:

• Severe life-threatening allergies to one of the substances found in a particular vaccine
• Severe reaction to previous vaccine
• Severe illness (not just a head cold), or a weakened immune system (possibly due to disease or medications being taken for a medical condition)

Your child's healthcare provider will be able to help you weigh the pros and cons of going this route.

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*Taken from, "The Immunization Decision" By Ann Douglas, Every Baby magazine, Issue Four.