Making an Educated Decision on Childhood Vaccinations

“What’s your view on vaccinations?”

It’s a question I receive commonly in the office, and I love the opportunity to share a comprehensive, balanced perspective with my patients. The truth is that there is so much information currently available to the public, from a wide variety of sources, and often with no shortage of strong opinion. As a naturopathic physician, my goal in the office is always to offer a clear lens of perspective, with consideration for the medical literature and my own clinical experience. For those parents with some concern or hesitancy regarding immunizations, I offer a wealth of resources and information to help them make decisions that they can feel comfortable with.

As stated, it is not uncommon for some people to come in with very strong opinions about vaccinations. While that is certainly understandable, I do find it important to first and foremost go beyond that initial strong response to a more nuanced discussion. Viewing each disease and associated immunization individually allows for a richer understanding, and allows for making educated decisions. It is worth keeping in mind that everyone involved in all aspects of the conversation has the same goal in mind – to keep your child as healthy as possible and minimize risk of serious disease. Throughout this article, I draw from the excellent work of Dr. Robert Sears, whose Vaccine Book and associated website I recommend as required reading for anyone looking to further a balanced informed perspective on the subject.

Why are they important?

While there are few subjects in medicine quite as charged as that of childhood vaccination, on first pass this might seem somewhat surprising. Consider the numerous diseases that have severely plagued humanity in the past, causing hundreds of thousands of deaths, including smallpox, polio, and diphtheria. These very real threats are now non-existent, thanks to the introduction of immunization. Admittedly, it’s quite a complicated conversation, but this fact cannot be denied. Even today, there are many places in the world where the risk of infectious disease is very present, and vaccination efforts are currently underway, saving many lives. Most of us in the United States are lucky to be distanced enough from these life threatening diseases, but it is important to keep this historical perspective.

What is a vaccine?

Simply put, a vaccine is a prepared substance that creates a protective immunity to a particular disease. The earliest record of vaccination goes back over 1000 years in China, and the modern vaccination effort can be traced to Edward Jenner’s smallpox vaccine in 1798, followed by Louis Pasteur’s work nearly 100 years later. Immunization research continues to develop with updated recommendations given each year by the Centers of Disease Control (CDC).

All vaccines are not created equal, and they are not equally important. As with any medical intervention, each vaccine carries some degree of risk, though it is important to balance that risk against risk of the disease itself, along with considering both the health of the individual and the greater local community of people. The current CDC schedule recommends immunization against fourteen diseases by the age of two. Here is a brief description of each disease:

Hepatitis B
Hepatitis B is a liver-damaging virus that is transmitted through blood or sexual contact. If contracted, there is risk of long term complications, including liver cancer. The virus can be transmitted from an infected mother to her child during the birthing process, though every woman is screened for infection prior to delivery. The vaccine is typically administered to the newborn in the hospital.

Rotavirus
Rotavirus is a virus that affects the gastrointestinal system, causing fever, vomiting, and diarrhea. It presents similarly to a common stomach flu, but has more severe symptoms that can last longer. It is relatively common, especially within daycare settings. There is no curative treatment other than supportive therapies. Severe cases necessitate hospitalization to avoid dehydration. Numerous infants and small children die annually from rotovirus.

Diphtheria
Diptheria is a bacterium that causes a potentially severe throat infection. It has become very rare since the advent of the vaccine. The diphtheria vaccine is part of the DTaP series.

Tetanus
Tetanus is a bacterium that causes severe widespread muscle and nerve paralysis. It is found is soil and tainted or rusty metal. It is now quite rare, especially among young children. The tetanus vaccine is part of the DTaP series.

Pertussis
Pertussis is a bacterium, commonly known as whooping cough. Not to be confused with croup (a more common and more mild childhood upper respiratory condition), pertussis is a relatively severe infection that first presents like the common cold, before worsening into the more aggressive phase consisting of extended coughing fits and difficulty breathing. While treatable at first onset, it often takes many weeks to months to fully recover. Despite the vaccine, pertussis is still very much present, and outbreaks are reported regularly throughout the country. The pertussis vaccine is part of the DTaP series.

Haemophilus Influenza type B (Hib)
Despite the word influenza, Hib is actually a bacterium which can cause meningitis, blood or brain infection, severe sore throat, or pneumonia. It is quite severe, though thankfully now quite rare since the advent of the vaccination.

Pneumcoccal Disease (PC)
Pneumococcus is a bacterium which can cause upper respiratory infections, ear infections, pneumonia, and meningitis. It is much more common than Hib, and while not always as severe, it is the most frequent cause of infant meningitis.

Polio
Polio is a virus that typically causes a minor upper respiratory infection. In some cases though, the disease invades the nervous system, where it can cause muscle paralysis that can be permanent. The good news is that there has been no polio in the United States since the 1980’s. The vaccine is given to keep it that way.

Measles
Measles is a virus that causes an upper respiratory infection, along with fever and rash. It is frequently mild, though there is risk of severe complication, including life threatening brain swelling. Incidence has been low, though numbers have increased in recent years. Outbreaks occurring in different parts of the country typically begin with a traveler returning from overseas, as was the case in California in 2015. The measles vaccine is part of the MMR series.

Mumps
Mumps is a virus that causes upper respiratory infection, along with swelling of the salivary glands below the cheeks. It is typically a mild presentation, but severe complications include swelling of the testicles or ovaries, arthritis, and infection of the heart or brain. It is quite rare, though occasional outbreaks have occurred over the past decade. The mumps vaccine is part of the MMR series.

Rubella
Rubella is a virus that presents as a fever, rash, and joint aches. It is very mild in nearly all cases. The concern is that a pregnant woman who contracts the virus can infect the growing fetus, causing a number of significant birth defects known as congenital rubella syndrome. The risk is highest during the first trimester of pregnancy, so screening may not catch it in time. Fortunately, the disease is very rare, with only a handful of cases reported annually. The rubella vaccine is part of the MMR series.

Varicella
Varicella is the virus that causes chickenpox, which typically presents as a fever along with the classic uncomfortable spotty rash. It is mild to moderate in most cases, though there is the very rare severe complication. As it was introduced in the mid 1990’s, many adults remember getting chickenpox during childhood. Symptoms can become more severe if the illness is contracted in adulthood. The varicella virus can be reactivated later in life in individuals who previously had chickenpox (or the vaccine), and present as shingles.

Hepatitis A
Hepatitis A is another liver-damaging virus, though infection is typically short lived and long term complication is virtually nonexistent. As compared to hepatitis B, this virus is transmitted through infected stool, and so is elevated risk within a daycare setting. Symptoms in children usually mirror a mild stomach flu, though symptoms can be more severe in older kids and adults.

Influenza
Influenza is the virus that causes the flu, that annual infection that comes through and infects many people, young and old, each winter season. It is unique among these diseases in that each year the strain of virus is different, so annual immunization is recommended to reduce risk of contracting the illness. Efficacy of the vaccination differs from year to year, as public health officials have to make educated guesses regarding that year’s strain. Though most people tolerate the flu relatively well, there are deaths every year, most often among infants and the elderly. The most recent news regarding the upcoming 2016-17 flu season is that the FluMist nasal spray is not recommended as it is not as effective as the injected vaccine.

Considering All the Factors

By considering each disease individually, it becomes obvious the decisions regarding vaccinations for your child should go far beyond a simple sweeping “yes” or “no”. Additionally, there are also the questions of other vaccination ingredients, combination vaccinations vs single administrations, standard scheduling vs alternative scheduling, and of course the weighing of individual risk.

Reducing Risk & Supportive Treatments

There are some simple steps that everyone should take to minimize the risks associated with any vaccine:

  1. First and foremost, ensure that your child is healthy prior to vaccination. If there has been a recent cold or fever, or seems like something might be coming on, go ahead and put it off for a bit. It’s worth waiting for the immune system to get back to a level of normal activity.
  2. Breastfeeding is recommended to keep your infant as healthy as possible during the first year, helping to confer additional immunity from mom.
  3. As your child gets older, a healthy nutrient-rich diet that limits refined sugars and junk foods is the best way to support a healthy immune system around the times of vaccination and in general.
  4. There are a number of supplements that can support healthy immune function and may decrease possible side effects, including vitamin C, vitamin A, and omega-3 fatty acids. Dosage and length of treatment varies, so be sure to consult with your physician.
  5. Probiotics have been shown to have significant immune supportive properties, and may help protect against negative effect. A study in adults showed that supplementation with the probiotic strain Bifidobacterium before and after administration of the influenza vaccine lowered rate of contraction of the flu, as well as rate of fever, with immune activity measurably higher in the probiotic group.

Talk with your doctor if your child has any history of adverse reaction to vaccination, or if there is any significant history of the same within your family. In our office, we work with parents to discuss all these complicated issues, in order to ensure that they are able to come to well-educated decisions that they feel comfortable with. Supporting the utmost health of each and every child is our top priority.

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