Vaccines, Thimerisol, Autism and Disease:   Bookmark and Share

The question of whether you should refuse vaccines

Everyday I'm in the office, without fail, I end up having a discussion with somebody about the safety of vaccines.   I can't blame you for being concerned.  The FDA and  pharmaceutical companies have not exactly covered themselves with glory recently with this VIOXX recall, and Prozac black box warning ( among others) making "approved" medicines look questionable.  And the websites devoted to vaccine injured kids are numerous, scary and persuasive.

There are a few problems here.  Most importantly, the kids who are unimmunized are at risk for very serious life- threatening diseases. These life -threatening diseases, fortunately, are not part of our day to day lives anymore so it's hard to do something to your healthy child and not see something immediately for your efforts. And autism, the bad thing that with which vaccines are most often associated, is not well understood and is a devastating diagnosis for the families it involves. 

The concerns:

Parents refuse vaccines because they don't want their child getting autism.  (Jenny McCarthy has done a nice job spreading the dangers of vaccines.  I hope you choose to get your information from more reputable sources.)    I also hear that it's better for the kids to get these diseases so that they can bolster their immune system.  And conversely, and sometimes in the same conversation, people don't want the shots given all at once because the immune system would be overwhelmed. I hear that the chances of getting the diseases are rare, so why get the shot?  Plus, and fortunately not as often, people tell me that they believe that the pharmaceutical companies, the government and health care professionals bought off  by drug companies are all in cahoots in an elaborate conspiracy to get kids immunized even when we know that bad things could happen.  I'll deal with the other concerns later, but this last one irritates me to no end.  I am a health care professional and if you think I'm hiding something or would recommend something that I knew would potentially seriously injure your child, it's time to find a new doc.  Our relationship is obviously shot. 

The diseases:

The question of whether or not kids should be vaccinated really needs to start with the diseases and not the side effect of the immunizations.  The vaccines the kids get are to protect them against potentially fatal diseases.  Immunizations have helped make diseases like polio and smallpox ones that we just get to read about.  In their time they were as frightening as HIV and SARS have been to us recently.

The vaccine for Hemophilus Influenza changed the way the I practice medicine.  That bacteria struck quickly, caused horrible airway obstruction and meningitis and killed more than a few children I that I took care of in my training.  After the vaccine came out, that disease became extremely rare.  Imagine trying to figure out if your child simply had croup or was developing epiglottitis, a rapidly progressive airway obstruction caused by Hemophilus. If you (or I) guessed wrong in the middle of the night, the results could have been devastating for your child because Hemophilus could close an airway permanently in 4 hours. Fortunately the vaccine is that good-- we just don't see the bacteria very often anymore.

Diseases like measles, tetanus, pertussis, pneumococcus, influenza and chickenpox are very much with us. Measles is the most contagious infectious disease.  90% of children need to be immunized to make sure that it doesn't spread if an outbreak occurs.  It always seems to be easier when the diseases are around to get kids immunized. (Remember the emails and phone calls you placed to my office when you found out your child couldn't get their flu shot or when pertussis broke out in the schools?) But polio, diphtheria, hemophilus, and rubella still exist in significant numbers in places outside the US. In today's global economy, and Racine is no exception, importation of the diseases is only an airplane ride away.  You don't have to live in a third world country to get a third world disease.  

How 'bout a few gentle reminders that these diseases really did exist and were horrible...for pictures click here.. and for reports on what has happened to children without these vaccines click here

Diphtheria:   Max cases in any one year: 206, 939     In 1998: 1

"In January of that year {1337}, there appeared a disease which spread fear and horror around.  It was a malignant and infectious inflammation of the throat, so rapid in its course that unless assistance was procured within 8 hours, the patient was past all hope of recovery before the close of the day."  Hecker 1517

Still in Russia with 150,00 cases and 5,000 deaths reported from 1990-1998.

Hemophilus Influenza type B:  Max cases in one year: 20,000   In 1998: 150

Measles:  Max cases in one year: 894,134   In 1998:  89

"Measles is an essentially dangerous disease in infancy and old age, though the danger is not  in the disease so much as in the sequelae it leaves behind it...Dr. Charteris, Glasgow1885

Causes encephalitis in 1 in every 1000 cases.

Mumps: Max cases in one year: 152,209  1998: 606

Polio:  Max:  21, 269   1998: 0

"The next morning when I swung out of bed my left leg lagged... I tried to persuade myself that the trouble with my leg was muscular, that it would disappear as I used it.  But presently it refused to work and then the other." Franklin Delano Roosevelt. 1921

1916 27,00 left paralyzed in an American epidemic, 6,000 die

1930:  Outbreak in Connecticut causes Wesleyan University to cancel its football season and prompts 121 students to quit school.  Public meetings were banned in LA.  1939:  Only 300 hospitals in the US were willing to care for patients with polio.

Chickenpox (Varicella) :  Now the leading cause of vaccine preventable deaths in children in the United States

Streptococcus Pneumoniae:  Worldwide, more than 1.2 million children die each year as a result of pneumococcal disease.  In children, pneumococcus costs the US healthcare system an estimated $1.5 billion annually. In developing countries, pneumococcus is the major cause of mortality in children under 5 years of age, accounting for 20-25% of the total mortality of this age group.

 

The preservative Thimerisol

Thimerisol is really interesting.  It's a preservative that's been used in vaccines since the 1930's, which means that most of who are parents now got it in our immunizations.  It's not in our vaccines now, but it wasn't taken out of vaccines because of concerns that it was causing disease.  It turns out that in the FDA Modernization Act of 1997, we asked the FDA to assess the risk of all mercury containing food and drugs  and so vaccine manufacturers, under our orders, found mercury in the form of thimerisol in many vaccines.  Theoretically, the thimerisol in the birth dose of the hepatitis vaccine may have been enough to exceed the government set limit of mercury exposure, so it was removed from that vaccine.  Since then (1999), it's been out of all vaccines in our clinic, except the multi-dose (adult) influenza vaccine.  We don't have thimerisol in our vaccines anymore.

In the meantime, while we were removing the thimerisol (that has still not been shown to cause any harm) ,the CDC received reports of children being born to moms who had Hepatitis B and who did not receive the birth dose of the vaccine and who were subsequently put at serious risk of getting the disease.  Hepatitis B virus causes hepatocellular cancer, a mean form of liver cancer, so the hepatitis B vaccine is a cancer-preventing vaccine.

Now, a bunch of credible scientific publications and agencies (The National Academy of Sciences’ Institute of Medicine, Pediatrics, the official Journal of the American Academy of Pediatrics) have done a bunch of research and have still not shown that thimerisol causes disease.  You could, I guess, distrust the whole government, and health community who believes these studies (including me) and think that we were all somehow confused by the research, but the studies look really good to me.  The Pediatrics study looked at  12 studies published between 1966 and 2004 investigating a link between thimerisol vaccines and autistic-type disorders and found no such link.  In fact, another study showed that when the Danes stopped putting thimerisol in their vaccines in 1992, the incidence of autism went up!

Plus, the range of potential mercury exposure after vaccines wasn't found to be toxic after all.

Autism:

Autism is regression of development at 18-24 months of age and is characterized by delay in language.  Failure to point at 1 year may be a warning sign and is what I look for at that visit in terms of verbal skills. Kids with autism don't read faces, have poor eye contact and tend to relate better to adults than kids their own age.  They have repetitive behaviors and do not engage in imaginative play.

The best explanation I've heard goes like this:  The brain is a plant, and plants, in order to grow well, need to be pruned every so often.  Our brain grows and every so often, the extra cell connections that don't serve a purpose or even get in the way, need to be pruned.  So, at 18-24 months, a "pruning" takes place and kids with autism over -prune and start losing the skills they previously developed.  Most docs who have seen kids with autism can recognize signs much earlier than 18 months.  I start looking in the first few well visits of the first year.

The amount of autism that we have seen has been going up.  It may be because we are better at finding it or are better at realizing what we are dealing with.  Instead of kids getting another diagnosis like "mental retardation," we are realizing the disease is really autism.

It is clearly a genetic disease.  Studies in twins show that if one twin has it, the other will 90% of the time.  Several chromosomes have been implicated.  It is found in families with a history autism, obsessive compulsive disorder, bipolar disease, anxiety disorders and ADHD.  There is a characteristic brain pattern very recently described which has lead researchers to speculate that the disorder starts as early as the 6th month of pregnancy.

It's clearly a devastating disease and I have seen and worked with brave and determined families that have kids with autism and I am always inspired by the courage they show.  It doesn't look though, like vaccines are to blame.

Critics of vaccines point to the increasing numbers of shots and blame them for the increases in autism.  That seems to ignore other things that may have changed during that time period.  Just to throw out an example- we use more sunscreen, and therefore get less Vitamin D, a potent immune system modulator.  And again, when you have a name for a problem, the rate that the disease occurs can only go up from the time when it didn't have a name.

 

The immune system:

The immune system is truly an amazing thing when it comes right down to it. It responds to any number of infectious particles every day and cause out body to do remarkable things to protect it from further disease.  It creates fevers so that the infection can't replicate as well, creates coughing and congestion so that the invading organism can't get farther into the body, makes antibodies to whatever comes along.  Those antibodies have a memory so that we don't get as sick when the infection comes along the next time.  It doesn't work as well when you are infant as when you are older, but the elegant system then uses antibodies from mom that crossed across the placenta and the infection fighting cells found in breastmilk to serve as a bridge until the baby's system is up and running.

Immunology is a complicated subject, but, to put it in ridiculously simple terms, you either have a working immune system or you don't. There are components to prevent entry of the infection into the body.  If that doesn't work, then there are cells that handle viruses, other ones that tackle bacteria, yeast, fungi.  There are cells that learn from the infection so you don't get it again.  There are cells for immediate response and others for longer-term protection.  Some cells catch, others destroy.  And other cells prevent your immune system from attacking things they aren't supposed to attack.   It can handle a lot. It has to. It can be affected by diet and stress.

 If you really stop and think about how many infectious particles we come across every day with normal interactions with other people (and even more when you consider school and day care!) it's a wonder we aren't sick all the time.  Multiple immunizations are not a problem for the beauty of the human body.  Through immunizations we are able to give the body a head start on the most aggressive diseases so that if we are exposed, we already have the plan of attack formed and ready to go and the antibodies can work without the help of fever, cough, congestion, chills, swelling and such that the immune system creates once the organism has invaded.  Making kids have these diseases so that they have a "stronger" immune system just means that we are going to make them sick before they can have the antibodies other kids got without getting sick.  And sometimes that sickness, and the body's attempts to defend against it, are fatal. 

Sooooo...

This is where I stand:

If you read all this and still don't want vaccines, I will respect that decision, as I respect all informed decisions you make about your child's healthcare.  You do have the right to refuse these vaccines.

And for the record, my 3 boys have been immunized with each of the recommended vaccines appropriate for their age.

 

Other food for thought 

 

 

 

 

Updated Jan 4, 2008