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Childhood Immunizations

pancake

Brilliant_Rock
Joined
Jan 7, 2010
Messages
1,547
I am a paediatrician (in Australia) and when I see a thread title like this I often go "Oh! Relevant!" then after clicking on it, whilst waiting for the page to load I kind of wonder whether it is a good idea for me to read it.

Obviously I am not unbiased. I have a few thoughts to share though...

I think your husband's "better be safe than sorry" approach is best applied to the practice of immunisation, not the the practice of NON-immunisation. The original "research" linking MMR to autism spectrum disorders has been thoroughly discredited in repeated peer reviews and is widely known within the paediatric community to be BS. Unfortunately once something like that has been stated, on such an emotive and hot topic, it can't be "unsaid".

I agree that schools, kindergartens and childcare centres should reserve the right to refuse enrolment to an unimmunised child. Immunisation has two protective faces - one to the individual child, and one to the community (referred to in medical circles as "herd immunity"). As an example: in Australia in the last few years we have had large outbreaks of pertussis, and babies have died. In terms of immunisation, this is due to a) older children having not been immunised, and therefore contracting the infection and passing it on to young, vulnerable and non-immune babies (immunised or not - immunity to pertussis is only partial until completion of the primary series); b) parents not vaccinating their babies; c) older adults who have lost their immunity passing the infection on to babies (again, immunised or unimmunised). It is a scary, scary disease and there is nothing more frustrating as a health professional than looking after a critically ill child with pertussis, knowing that if community education and vaccine coverage were better, this kid would be healthy.

A side issue is multiplicity of vaccines in one injection, and the preservatives used in them. I can't speak for other places, but here vaccines no longer contain thiomersal (hence no mercury concerns), and more widely, there is no evidence of benefit/lessening of adverse effects by splitting combined vaccines or changing the spacing of the vaccines. All are carefully planned for maximal immune response and community benefit.

My experience is that society forgets that the infections covered by the immunisation schedule actually kill people. In the bad old days pre-immunisation, kids died - HEAPS of kids died - of measles, pertussis, diphtheria, epiglottitis, etc etc, the list goes on. It is the privilege of sustained good health - as a society - that leads people to believe that these infections just don't exist any more (so untrue) and that they are some kind of archaic relic from the deep dark past. Because the benefits of immunisation are often "invisible" to the community (ie. they don't see the infection...they don't "see" the benefit of immunisation), it is easy for misinformation to spread and for people to be mislead into thinking it is non-essential or non-useful - or even harmful, as I often encounter when talking to families at work.

I question the utility and/or wisdom of consulting parenting boards for advice on such a topic. I am not saying that doctors/health professionals are the be-all and end-all, but you are not going to be presented with empiric, rigorous evidence on a parenting board - it is going to be a mish-mash of opinions of varying substantiation and loads of emotion tossed in. Many tertiary paediatric centres have an immunisation clinic or service where professionals are available to discuss the pros and cons based on the international knowledge, without the obligation to go ahead. This would be a good starting point if you are looking to educate yourself.

My last word on this (for today!) is that there is no question I will immunise my kids according to the schedule. Heck - the more vaccines the better. Ditto for advice to my friends.

/soapbox
 

pancake

Brilliant_Rock
Joined
Jan 7, 2010
Messages
1,547
OK, so that wasn't my last word :) I just wanted to add a point about my practice as a clinician in situations where parents are unsure, or have already decided not to vaccinate, as that was one of the questions asked by the OP.

I accept that I'm not going to change the views of every parent I meet who has a differing view on immunisation. That said, I strongly believe that I am failing my duty of care if I don't open that discussion and don't make an effort to help parents see the benefits of vaccination. I also believe in harm minimisation and to that end, my purist views on the need to vaccinate do not stop me from discussing selective vaccination with parents, IF that is what they are receptive to. In my experience, this is the same as any situation where people are sensitive about a controversial topic - it is easy to get them on the defensive and for them to stick their head back in the sand, none of which is useful to the discussion at hand. Usually I try to gauge where they're at (eg. "100% anti, immutably"; "previously anti, now reconsidering in the context of their child's current pneumonia/meningitis/whatever"; "ambivalent" - you know, stages of change etc etc) and then nudge the conversation accordingly.
 

LtlFirecracker

Ideal_Rock
Joined
Feb 29, 2008
Messages
4,837
I think a lot of people have chimed in with some really good stuff and I don't want to repeat it.

For the Hep B. Babies can get it from the delivery. Because it's mode of transmission has a social stigma attached to it (sex and drugs) women are not always honest about what they are doing. It is screened for at some point in the pregnancy, but there is a time window between pregnancy and delivery where she could contract it.

I think we as a society are not used to seeing sick children anymore. I just had a patient who got meningitis and the culture grew what we call non-typable H flu. We immunize against the type B version of H-flu (the Hib shot). She ended up doing very well with no long term neurological problems. Before the Hib B immunization, the type B strain was the most common strain of this bacteria and caused terrible meningitis, and a condition called epiglottis. Epiglottis is a disease that can threaten a child's airway. But that has been selected out of the population due to immunizations, and now the less serious strains are the problem we are dealing with. The mother asked me why they called it non-typable H-flu and I explained to her there is H flu type B and all the others. I told her if this was type B, we would probably be having a different conversation right now. She could not believe things like this existed, and at the same time felt grateful that her daughter did so well.

We can't immunize against everything, the diseases we do immunize against do not cause complications in everyone, but in enough people that it was too many.

If a parent wants to space shots out, I present them the evidence as to why giving multiple immunizations is safe, but I tell them at the end of the day it is their choice. However, when I have kids, I will be immunizing them by the CDC's recommended schedule.
 
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