Early-life Infections, Immunizations May Alter Childhood Asthma Risk

[miriam]

"Combined diphtheria, tetanus DT immunization in the first year of life was also linked to the risk of childhood asthma in the prospective study.  " (24)

http://www.immune.org.nz/default.asp?a=1096&t=1032&View=FullStory&newsID=187

One of those peer reviewed scientific journal studies. 

[stik]

From later in the article:

Dr. Thomson said she was not aware of other studies that reported an association between combined DT vaccination and asthma. She emphasized, however, that the study does not suggest a "causal link." Rather, it shows a statistical association "for which a range of explanations (some noted above) may apply."

"While chance is an unlikely explanation for the finding, it can not be eliminated completely; nor can unknown or recognized confounders for which we lacked data be definitively excluded," Dr. Thomson said.

Importantly, she added, the association between combined DT and the later development of asthma "should not deter parents from immunizing their children when weighted against the benefits."

The study also found that oral polio immunization in the second year of life was associated with a decreased risk of asthma at 6 years (crude RR, 0.60; adjusted RR, 0.63).

"Early childhood immunizations that are administered orally such as Sabin and/or more recently introduced immunizations such as the rotavirus vaccine may offer benefit in preventing the development of childhood asthma and other allergic diseases," Dr. Thomson said.
Pediatr Allergy Immunol 2010.

[miriam]

Of course they always say that the facts should not deter parents from sacrificing their children up to the vaccines.  

Do doctors ever tell parents that the vaccine can cause and or is associated with the development of asthma? Do doctors ever do a history of both of the parents' family backgrounds to determine if a vaccine is appropriate for the newborn?  Doctors never say that a child should not be vaccinated.  

[stik]

It would be pretty weird for doctors to tell patients that vaccines can cause asthma based on one study in which asthma was statistically linked to one combo vaccine given to, if I read it correctly, two percent of patients.

I have only ever dealt with my own doctors and my children's. I have no idea what doctors, in aggregate, always or never say. Doctors I have worked with have always been willing to answer my questions and respond to my concerns. There is a list of circumstances under which vaccination is contraindicated. I have been shown it, though I didn't memorize it.

Diphtheria is pretty darn bad. Asthma is pretty manageable. New Zealand, where this study was conducted, is a small country in Oceania. Doctors there may need to account for a relatively high possibility that their patients will travel to developing nations where diphtheria is a more serious risk.

I think the potential connection between asthma and gastroenteritis is intriguing. Thank you for sharing the article.
Edited by stik - 6/13/11 at 7:39am

[ammiga]

Originally Posted by stik 

It would be pretty weird for doctors to tell patients that vaccines can cause asthma based on one study in which asthma was statistically linked to one combo vaccine given to, if I read it correctly, two percent of patients.

I have only ever dealt with my own doctors and my children's. I have no idea what doctors, in aggregate, always or never say. Doctors I have worked with have always been willing to answer my questions and respond to my concerns. There is a list of circumstances under which vaccination is contraindicated. I have been shown it, though I didn't memorize it.

Diphtheria is pretty darn bad. Asthma is pretty manageable. New Zealand, where this study was conducted, is a small country in Oceania. Doctors there may need to account for a relatively high possibility that their patients will travel to developing nations where diphtheria is a more serious risk.

I think the potential connection between asthma and gastroenteritis is intriguing. Thank you for sharing the article.

I would never describe my 30 year battle with asthma that way. It was scary, painful, expensive, frequently life threatening, and constant for nearly three DECADES. The hospital staff knew my family, as I showed up there several times a month, unable to breathe. I was on several drugs a day for 30 years. I spent most of my childhood on the sidelines watching kids play, because if I joined them I would wind up on a nebulizer. My asthma had a laundry list of triggers, as well as spontaneous onset.

I'm not singing the praises of diphtheria. I'm just saying don't be so flip about asthma. People need to weigh which illness they are more comfortable handling, should their child develop a case. Full information of risks would be nice so parents can make an accurate decision.

If diphtheria is only a risk if the individual is traveling, then maybe that is the only time it should be looked at.

[stik]

My dd has asthma, and I don't take it lightly either.  I just agree with the researchers' conclusion that the benefits of diphtheria vaccination outweigh the risks, and that it is not yet clear why there is a correlation between ONE combination vaccine for diphtheria and later asthma, and not between asthma and other combination vaccines that also protect against diphtheria.  

I think it's also worth noting that, if one reads the article summary as a whole rather than picking out a single sentence, the researchers found another vaccine that's correlated with lower risk of asthma.  

[ammiga]

And many might feel that given their living situation, the risk of diphtheria is pretty much zero, so any risk of anything else (like asthma) isn't worth it.

One major problem with the current vaccine schedule is that it is one-size fits all. But that is absurd. If a child is at an increased risk for asthma (say genetics, city they live in, whatever) and at virtually no risk for diphtheria, and a study shows an increased risk of asthma (even if it's slight) associated with a certain vaccine, then that child shouldn't get the vaccine. But no vaccines are addressed this way, and that is of great concern to me. It's never about what's best for my child, and my child has very different risk factors than children in general.

[raelize]

yes, but if everyone who could possibly be at risk for asthma didn't get diptheria vaccine, then it wouldn't be a zero chance, would it? eventually it would find its way in from the other countries.

[stik]

This study indicates that children with an increased risk for asthma should get a different diphtheria vaccination other than the DT.  The study didn't identify a cause for the correlation between asthma and DT combo vax, but it did show that other combos with the diphtheria vax aren't linked to increased risk of asthma.  So parents with a family history of asthma might want to look out for that.  No clinical recommendations are going to change based on an inconclusive observation about 2% of the subjects in a study published in a tiny journal.  Remember, the researchers saw a correlation affecting a small number of the children in the study and did not feel they had enough information to identify the cause of the correlation.  They don't have the data to say that the DT is causing asthma.  It's entirely possible that some other factor is causing children who are likely to get asthma to also be likely to get the DT vax.  Could be geography, or plans for travel to the developing world, or pre-existing history of respiratory conditions, or something else equally random.  This was an observational study of the relationship between asthma and gastroenteritis, not a study of the impact of vaccines.  Correlation is not causation.  Nonetheless, asking for the DTP or DTaP instead of DT won't be an issue unless there's another shortage.  I suppose you could also request the oral polio vax, as it's correlated to lower asthma risk (again, inconclusively) though that one's unusual in the US.  It can't hurt to try.

If you're confident that your child will neither travel to a country where diphtheria is endemic, nor have contact with anyone who has traveled to a country where diphtheria is endemic, you might be safe skipping that vaccination.  There hasn't been a human case in the US since 2003.  The CDC is concerned about asymptomatic carriers continuing to circulate the infection, and about the possibility of outbreaks among older adults.  So I guess you could look out for that.  

My doctors are completely willing to address vaccines as they relate to the risks to my particular children and their personal and family histories.  And my doctors are pretty mainstream.  I'm sorry you've had trouble with yours.  

[ammiga]

It's not about doctors being willing to address risks for particular children if their parents bring it up. Individual assessment should be the standard from the beginning. It's not. That's wrong. Every child deserves to be given a custom risk/benefit analysis, and not given the responsibility to take a risk to protect everyone else.

[stik]

I disagree.  Like snowflakes, every child is unique, but also like snowflakes, they all have a lot in common.  From an immunological perspective, the really special ones tend to stand out.  

In the vast majority of children, a careful, individualized analysis would lead doctors to recommend administering the typical vaccines on the typical schedule. Carrying out millions of individualized risk/benefit analyses on healthy children every year would dramatically reduce the time that physicians have available to spend on patient care with no measurable benefit, because adverse reactions to vaccines are rare and unpredictable.  

As with any situation in which you receive a service, if you want something special, you have to ask.  

[SilverMoon010]

Originally Posted by stik 

I disagree.  Like snowflakes, every child is unique, but also like snowflakes, they all have a lot in common.  From an immunological perspective, the really special ones tend to stand out.  

In the vast majority of children, a careful, individualized analysis would lead doctors to recommend administering the typical vaccines on the typical schedule. Carrying out millions of individualized risk/benefit analyses on healthy children every year would dramatically reduce the time that physicians have available to spend on patient care with no measurable benefit, because adverse reactions to vaccines are rare and unpredictable.  

As with any situation in which you receive a service, if you want something special, you have to ask.  

We're not talking about doctors administering one vaccine here or there. We're talking about 6 to 8 vaccines at one visit! That certainly calls for some heavy-duty risk/benefit analysis IMO.  Forget the doctor's precious time, although you're right, doctors don't take the time to look at each child individually and I think that is sad.  They just inject and wash their hands of it.

You can't tell what underlying health issues a child has when they are first born, even at 2, 4, 6, months etc. They may have underlying health issues that haven't surfaced yet, but let's still vaccinate them anyway because "that's the thing to do."   To go by the one-size-fits-all criteria is absurd.  I don't care how healthy the child "appears."

[ammiga]

Originally Posted by stik 

I disagree.  Like snowflakes, every child is unique, but also like snowflakes, they all have a lot in common.  From an immunological perspective, the really special ones tend to stand out.  

In the vast majority of children, a careful, individualized analysis would lead doctors to recommend administering the typical vaccines on the typical schedule. Carrying out millions of individualized risk/benefit analyses on healthy children every year would dramatically reduce the time that physicians have available to spend on patient care with no measurable benefit, because adverse reactions to vaccines are rare and unpredictable.  

As with any situation in which you receive a service, if you want something special, you have to ask.  

A lot in common? Sure. But some of their differences matter in a major way. Do you truly believe a child who is breastfed is at equal risk for complications from Hib or rotavirus as one who is formula fed? Especially if the child stays home? That requires very little time to determine, and could easily result in a risk/benefit analysis in favor of not giving those vaccines.

You will never convince me that potential risk factors in a newborn stand out. Nor a 2-month old, or a 4 or 6-month old. It's seriously not even worth your time to try.

My exact point is, custom medical care for children (or adults) should not be special. It should be standard.

[stik]

Originally Posted by SilverMoon010 

Originally Posted by stik 

I disagree.  Like snowflakes, every child is unique, but also like snowflakes, they all have a lot in common.  From an immunological perspective, the really special ones tend to stand out.  

In the vast majority of children, a careful, individualized analysis would lead doctors to recommend administering the typical vaccines on the typical schedule. Carrying out millions of individualized risk/benefit analyses on healthy children every year would dramatically reduce the time that physicians have available to spend on patient care with no measurable benefit, because adverse reactions to vaccines are rare and unpredictable.  

As with any situation in which you receive a service, if you want something special, you have to ask.  

We're not talking about doctors administering one vaccine here or there. We're talking about 6 to 8 vaccines at one visit! That certainly calls for some heavy-duty risk/benefit analysis IMO.  Forget the doctor's precious time, although you're right, doctors don't take the time to look at each child individually and I think that is sad.  They just inject and wash their hands of it.

You can't tell what underlying health issues a child has when they are first born, even at 2, 4, 6, months etc. They may have underlying health issues that haven't surfaced yet, but let's still vaccinate them anyway because "that's the thing to do."   To go by the one-size-fits-all criteria is absurd.  I don't care how healthy the child "appears."

No, we're not talking about one vaccine here or there.  Yes, there can be a lot in one visit (though not 6-8 unless you've fallen behind on the schedule).  That certainly does call for heavy-duty risk/benefit analysis.  In aggregate, that analysis has been done.  No, you can't tell what underlying health issues a child will have at a young age.  However, very few underlying health issues are contraindications for vaccination.  And yes, if you are trying to serve the public health goal of vaccinations, which is to limit outbreaks of disease in a population, vaccination and hand-washing are "the thing to do."  

Most docs take a family history in which they check for things like food allergies, chronic illnesses, medical conditions suspected of having a genetic component, and a bunch of other stuff, when they first meet a patient.  Beyond that, how healthy a child appears is a generally sound criteria for identifying a healthy child.  In fact, that is the long-standing diagnostic standard for spotting healthy children.  

If you think your particular children are unique in a way that merits more thorough analysis, you should tell your doctor.  
 

[miriam]

 Yes, there can be a lot in one visit (though not 6-8 unless you've fallen behind on the schedule).  

Be careful with this logic.  In saying this, one is able to blame Mrs. Poling for her daughter getting so many vaccines at one visit. BLAME the parent! It is the doctor's responsibility if he is hired by the parents to make the most correct decision for the child's health. 

[SilverMoon010]

Originally Posted by stik 

If you think your particular children are unique in a way that merits more thorough analysis, you should tell your doctor.  
 

Thanks for the suggestion but I actually was speaking of all children in general, not my own in particular.  I see all children as very special and deserving of time from doctors when it comes to their health and future.

Edited by SilverMoon010 - 6/14/11 at 2:12pm

[stik]

That's some intensive post-modern analysis of my statement there.  Let me assure you that the Poling family was very, very far from my thoughts when I wrote that.  

[Bokonon]

Originally Posted by stik 

Most docs take a family history in which they check for things like food allergies, chronic illnesses, medical conditions suspected of having a genetic component, and a bunch of other stuff, when they first meet a patient.  Beyond that, how healthy a child appears is a generally sound criteria for identifying a healthy child.  In fact, that is the long-standing diagnostic standard for spotting healthy children.  

And this is all obvious and apparent in a 2-month old?

[stik]

All what is apparent in a 2-month old?   

[Bokonon]

Originally Posted by stik 

All what is apparent in a 2-month old?   

" food allergies, chronic illnesses, medical conditions suspected of having a genetic component"

"how healthy a child appears is a generally sound criteria for identifying a healthy child"