Vaccination and the risks to your child’s health
A Pediatrician's Perspective

The increasing wave of apprehension and skepticism regarding the absolute safety of vaccinations for our young has cast a shadow over physician’s efforts to assure that “no child be left behind” in the area of protection from infectious diseases.  While a study in 2004 reported that 0.7 % of families refuse all vaccinations for their infants, a growing majority of parents have trepidation that their decision to go ahead and vaccinate may result in negative consequences: a “weakened immune system”, allergies, asthma, diabetes, inflammatory bowel disease, Guillain-Barre syndrome, and most notably Pervasive Developmental Delay or Autism.  The two biggest players on the vaccine scare stage are Thimerosal (a mercury containing preservative) and the MMR (Measles-Mumps-Rubella) vaccine.  Each of these issues has taken on a life of its own.

Neurologic dysfunction associated with organic mercury poisoning through ingestion of contaminated fish is well documented. Birth defects from intrauterine exposure have also been reported. The trace amount of Thimerosal used in any particular vaccine is negligible.  In 2001, however, the Federal Drug Administration determined that the large number of vaccinations incorporated into the schedule had the potential to expose children to cumulative doses of mercury that would exceed the safety limit established by the Environmental Protection Agency.  Finding the connection between Thimerosal in vaccines and neurodevelopmental disorders, such as Autism, “biologically plausible”, Thimerosal was removed from all vaccines except for influenza.  A number of large epidemiologic studies conducted both inside and outside of the United States followed and supported no link between Thimerosal-contained vaccines and autism. However, in the name of absolute safety, Thimerosal continued to be eliminated.  Since the influenza vaccine has recently been recommended even for healthy children between 6 months and 5 years of age, a Thimerosal -free flu vaccine is now available.

The issues implicating the MMR vaccine as a trigger for Autism have been more emotional than scientific.  The landmark report in Lancet by Wakefield and colleagues in 1998 described 12 children who had intestinal symptoms and autistic regression diagnosed in the second year of life in the months following the reception of the MMR vaccine.  “Footprints” of the measles virus were noted on the pathologic examination of the intestines.  The authors posited a cause and effect relationship based on their limited data; a media frenzy resulting in a congressional debate ensued. 

A spate of published studies conducted since 1998 have refuted the MMR-Autism connection, examining the issue from every angle. In 2004, 10 of 12 coauthors retracted the suppositions of their 1998 report.

Furthermore, more and more scientific evidence indicates that abnormalities in the brain leading to Autism occur well before birth and a strong genetic link is being formulated.  It is presently impossible to predict whether any one rare individual (especially a hyperallergic individual) may have a heightened vulnerability to the MMR vaccine as an immunologic trigger.  Currently, techniques to screen infants as vulnerable for “acquisition” of developmental problems are on the horizon.  The concept of Single Nucleotide Polymorphisms (SNPs) has elucidated the possibility that the unique genetic configuration of any one individual can result in an idiosyncratic reaction to external factors such as allergens.

Several new vaccines such as Rotavirus (Rotateq) and Human Papillomavirus (Gardasil) are now available.  Will they add fuel to the fire?  The controversies discussed above are not easily extinguished. Thirty-nine percent of pediatricians feel so strongly about ensuring the safety of infants through vaccination that they would dismiss a family from their practice for refusing all vaccines; the American Academy of Pediatrics does not support this drastic measure.  In this age of informed consent, I personally feel that parents have a right to decide what is beneficial for their offspring as long as they are receptive to education regarding the pros and cons and willing to accept the risks of refusal or delay.  Most pediatricians and family practitioners are becoming open-minded and flexible and able to empathize with the present “angst” regarding vaccine harm.  Hopefully in the long run mutual trust will prevail in this area and in all other areas of society

Editorial provided by Dr. Anthony Kovatch of Pediatric Alliance - Arcadia Division.