Vaccinations: Questions to Ask Your Doctor

[Turquesa]

I’ve been wanting to do a thread like this for awhile!

An article on vaccinations in the journal Pediatrics reminds physicians:

Health care providers are legally obliged to obtain informed consent before treating a patient.

And the Centers for Disease Control  tells doctors:

Parents should be helped to feel comfortable voicing any concerns or questions they have about vaccination, and providers should be prepared to listen and respond effectively.

So I say…..what are we waiting for?  Let’s bring on the questions! 

I need YOUR contributions to compile a list of questions about vaccinations that parents may wish to ask their providers.  (You can also use these on anyone else in a vax discussion).

The SECOND post in this thread will contain the questions “filed” under different categories.  To keep the questions in a central location, I will periodically update the post with new contributions.

Some things to keep in mind before you post:

1. Please participate only if you understand and agree with the merits of this approach---namely, asking a provider questions before consenting to or declining vaccination for you or your child.  Please do NOT post to discuss or debate somebody’s questions.  The goal is is to keep this thread FOCUSED on questions about individual vaccines, vaccines in general, and vaccine-avoidable diseases.

1. Please contribute questions whether you are pro-vaccine, anti-vaccine, pro-delayed/selective vax, or completely undecided.  Even if you intend to follow the recommended schedule, remember that even pro-vax sources reiterate that you have the right to ask questions before consenting to vaccination.  http://www.parenting.com/health-guide/vaccines/doctor

I honestly see no reason to exclude any reasonable questions contributed to this list.  This resource is for you, as a parent, to use at your discretion, so you may skip any questions that don’t concern or apply to you.

1. These questions should be delivered with a diplomatic tone and wording; they are to inspire discussion and not debate!  They may be challenging and thought-provoking.  (Some of you may disagree, but I personally find no problem asking questions to which I already know the answer…worth it if it gets the doctor thinking!  ;-) )  On the other hand, we’re not out to play a game of Stump-the-Doc! 

Some things to keep in mind before asking your provider these questions:

Supposedly there are doctors out there willing to dedicate a separate appointment to discuss vaccination with parents.  (I say “supposedly” because I haven’t personally experienced this…yet).  I’ve also heard of email correspondence, but again, that doesn’t seem to be an accepted practice in my area.   

1. Experienced parents already know this: Well-Child Visits are QUICK (well….at least your encounter with the doctor is.  I’m making no promises about the wait time ), so you’ll only get a chance to ask maybe 2-3 of these questions.  Pick the ones that matter to you most and seem most relevant to your situation.

They may also believe that you do your “research” on celebrity websites and conspiracy theory blogs.  A good many are waiting for you to ask if vaccines cause autism so that they can quickly answer that “all of that’s been debunked.”  Others will have canned answers ready for a few other questions. 

My point is….you may catch them off-guard with some of the questions in this thread.  A good provider will be will to provide an answer that is deliberate, thoughtful, and genuine (vs. rehearsed or dismissive).  Assume that they are well-intentioned and genuinely have your child’s best interest in mind. 

1. Patiently keep in mind that most providers have been led to believe—by their colleagues and by mainstream media—that unless you fully vax your children, you are *scared* (not *skeptical*) and that all they need to do is address your “fears.” 

1. Another test of a good provider lies in how respectfully and thoroughly s/he handles your questions.  Answers that are hyperbolic, dismissive, emotionally manipulative, (i.e. resorting to guilt and fear), condescending (e.g. implying that only a doctor can do “real” research), or bullying, (telling you in so many ways to vaccinate your kid “or else”) are obviously grounds for finding a new provider.  Answers that are anecdotal, (“I have patients who…,” “During my residency, I saw…”) may require some gentle prodding for actual science and data.  Just remember the importance of mutual respect.  It does no good to paint a provider into a defensive corner, and s/he shouldn’t do the same to you!  

Good luck!  Now let’s get that list going!

[Turquesa]

VACCINATIONS: QUESTIONS FOR PROVIDERS

I’m opening with a few to get the ball rolling, but please chime in! 

Resources (Various Biases!) for Asking Questions:

Parenthood.com (Article by Robert Sears, M.D.)

http://www.parenthood.com/article-topics/how_to_ask_questions_about_vaccines_without_getting_kicked_out_of_your_doctors_office.html/page/1

Parenting Squad:

http://parentingsquad.com/questions-to-ask-your-pediatrician-about-vaccines

Parenting Magazine:

 http://www.parenting.com/health-guide/vaccines/doctor

General Questions about Vaccines and Vaccine-Avoidable Diseases (for questions that don’t fit into the more specific categories below):

1. In terms of percentage, how effective is this vaccine after the first dose?  After each subsequent dose?
2. What should I do if my child has a bad reaction to this/these vaccines?
3. Quantifiably speaking, what are my child’s chances of catching Disease X if vaccinated vs. unvaccinated?  What about catching AND spreading it? 
4. Do you have a list of ingredients for this/these vaccine/s?  Has there been any independent, longitudinal research on the safety of these ingredients?
5. I understand that vaccine manufacturers are no longer producing separate component vaccines.  If I choose not to get the combined version, do you know where I can get separate components?  (e.g. Canada or Mexico?)
6. What is the aluminum content in this vaccine?  Do you know where I can get a hold of brands with lower aluminum content?
7. So far, the only research that I have seen on vaccine safety compares vaccinated children to other vaccinated children.  There hasn’t been any true placebo done on unvaccinated children.  Do you know of any research that compares vaccinated children to unvaccinated children?  Or do I just need to put my faith in the current vaccine safety research, despite this notable scientific limitation?
8. In light of the 1986 Law, (NCVIA), how do I know that you, the dr, have been provided with enough "relevant" information to actually give me informed consent? Who makes this call what is "relevant"? Why is "death" not listed on the vis, since that has been compensated for by the Vaccine Court? Can you show me the studies proving the "one in a million" severe reaction rate?

   http://www.cdc.gov/vaccines/pubs/vis/

9. Can you please tell me about studies done proving the safety of adjuvants, particularly aluminum? There seems to be a large body of research that would cause concern about aluminum.

10. If vaccine safety studies do not use true placebos, screen out any children with potential health or familial health problems, and only use small numbers with very limited followup, how do I know a vaccine is truly safe for my child and that the reaction rates published in the insert are reflective of real potential rates for my child?

11. What pressures are on you maintain high vax compliance rates? Is it true that some drs. receive financial or other incentives in keeping high vax rates? 

Anthrax (for questions about this vaccine or the disease)

BCG (for questions about this disease or tuberculosis)

1. Can someone who has had bcg be checked with skin test later on in life? Do you know at what rate the BCG vax could cause false positives? What is the preferred method of testing for TB in someone who has had BCG?

Combination Vaccines, Misc. (for questions about any of the various combination vaccines not otherwise addressed---e.g. MMRV, Pentacel—and the diseases that they address).

DTaP (for questions about this vaccine or diptheria, tetanus, or pertussis)

1. The last time I viewed an insert for this vaccine, it stated that there was no research proving that the pertussis component prevented transmission.  Has any research to the contrary come out since that time? 
2. What do you know about treating Pertussis with Sodium Ascorbate?

3. In what situations (especially when delaying), are 3 or 4 initial doses of DTaP necessary? Evidence in Daptacel product insert seems to suggest efficacy is just as good at 3 doses as 4 doses, as per a study done with Swedish infants who only received 3 doses at 2,4,6 months and acheived efficacy level equivalent to American infants receiving 4 doses at 2,4,6, 15 months.

Haemophilus Influenzae Type B (Hib) (for questions about this vacine or the disease)

Hepatitis A (for questions about this vaccine or the disease)

1. If Hep A is largely non-symptomatic in children, and/or I feel I am at low risk for this illness, why would this vaccine be necessary?

Hepatitis B (for questions about this vaccine or the disease)

1. Why does my newborn need Hep B, as I am negative and as I understand it, Hep B is mainly transmitted through sexual contact or sharing needles?

Human Papillomavirus (HPV) (for questions about this vaccine or the disease)

Influenza (for questions about this vaccine or the disease)

IPV (for questions about the inactivated poliovirus vaccine or polio)

Japanese Encephalitis (for questions about this vaccine or the disease)

Meningococcal (for questions about this vaccine or the disease)

1. Do you have the numbers for recent outbreaks? And which strand caused outbreak? I understand no vaccine covers B.

MMR (for questions about this vaccine or measles, mumps, or rubella)

1. What do you feel would be a true accurate number for risk of Measles encephalitis? I have seen great variation.

Prevnar/Pneumococcal Disease (for questions about Prevnar or pneumococcal disease)

Rabies (for questions about this vaccine or the disease)

Rotavirus (for questions about this vaccine or the disease)

1. Are the rotavirus vaccines still contaminated with dna from pig viruses? As of 2010? Why were there pig viruses in these vaccines to begin with, as the only animal product I can find on the ingredients is bovine? What studies have they done to ensure that this contamination has not nor will not harm children who received contaminated vaccine?

Shingles (a.k.a. Zoster) (for questions about this vaccine or the disease)

Smallpox (for questions about this vaccine or the disease)

TDaP (for questions about this vaccine or diptheria, tetanus, or pertussis)

Typhoid Fever (for questions about this vaccine or the disease)

Varicella (for questions about this vaccine or the disease)

1. As chicken pox is normally without serious complications, and natural immunity is preferable, why would this vaccine be necessary?

2. Could you please quantify for me, to the exact percentage point, my child's chances of dying from varicella?  What was the pre-vaccine mortality rate for varicella?  (Answer: 0.0000043% )

3.  What do you think of the idea that shingle is on the rise, and among younger people, due to the fact that chicken pox is not so common anymore, and people are not having their immunity boosted through exposure?  

Yellow Fever (for questions about this vaccine or the disease)

Edited by Turquesa - 5/17/12 at 4:47pm

[slmommy]

General -

1. In light of the 1986 Law, (NCVIA), how do I know that you, the dr, have been provided with enough "relevant" information to actually give me informed consent? Who makes this call what is "relevant"? Why is "death" not listed on the vis, since that has been compensated for by the Vaccine Court? Can you show me the studies proving the "one in a million" severe reaction rate?

http://www.cdc.gov/vaccines/pubs/vis/

Quote:

In addition to broad liability protection, the 1986 Law also provides another shield to manufacturers under federal law. (48) The 1986 Law permits them the right to not disclose known risks to parents or guardians of those being vaccinated. Resting on the "learned intermediary" doctrine, manufacturers bear no liability for giving, or failing to give accurate or complete information to those vaccinated, and have only to provide relevant information to doctors, who must give patients CDC Vaccination Information Statements.(49)

 

http://digitalcommons.pace.edu/cgi/viewcontent.cgi?article=1681&context=pelr (quote on pg 9).

http://www.law.cornell.edu/uscode/text/42/300aa-22 (the text referred to by footnote 48).

2. Can you please tell me about studies done proving the safety of adjuvants, particularly aluminum? There seems to be a large body of research that would cause concern about aluminum.

3. If vaccine safety studies do not use true placebos, screen out any children with potential health or familial health problems, and only use small numbers with very limited followup, how do I know a vaccine is truly safe for my child and that the reaction rates published in the insert are reflective of real potential rates for my child?

Hep B -

4. Why does my newborn need Hep B, as I am negative and as I understand it, Hep B is mainly transmitted through sexual contact or sharing needles?

DTaP -

5. What do you know about treating Pertussis with Sodium Ascorbate?

MMR -

6. What do you feel would be a true accurate number for risk of Measles encephalitis? I have seen great variation.

Hep A -

7. If Hep A is largely non-symptomatic in children, and/or I feel I am at low risk for this illness, why would this vaccine be necessary?

Chicken Pox -

8. As chicken pox is normally without serious complications, and natural immunity is preferable, why would this vaccine be necessary?

Rota -

9. Are the rotavirus vaccines still contaminated with dna from pig viruses? As of 2010? Why were there pig viruses in these vaccines to begin with, as the only animal product I can find on the ingredients is bovine? What studies have they done to ensure that this contamination has not nor will not harm children who received contaminated vaccine?

Another General - 

10. What pressures are on you maintain high vax compliance rates? Is it true that some drs. receive financial or other incentives in keeping high vax rates? 

Meningococcal - 

11. Do you have the numbers for recent outbreaks? And which strand caused outbreak? I understand no vaccine covers B.

ETA: OP, I was looking at your list, there is a vaccine for malaria???

Edited by slmommy - 4/2/12 at 8:39am

[emmy526]

Originally Posted by slmommy 

ETA: OP, I was looking at your list, there is a vaccine for malaria???

here is a link to a study they are doing involving infecting goats with malaria to convey a vaccine thru their milk...what next?!

http://articles.mercola.com/sites/articles/archive/2012/03/20/genetically-engineered-goats-produce-vaccine.aspx?e_cid=20120320_DNL_art_2

[Turquesa]

Slmommy, I can't find the link right now (of course ), but I was working from a CDC page listing all of the adult vaccines.  It looks like the malaria vaccine is still under development, though, so I'll remove it from our list of vaccines until the FDA approves it. 

[Taximom5]

I can't improve on that list at all--fabulous job!

[prosciencemum]

Originally Posted by Turquesa 

2. Could you please quantify for me, to the exact percentage point, my child's chances of dying from varicella?  What was the pre-vaccine mortality rate for varicella?  (Answer: 0.00000043% )

I was curious about your stat, so I followed the link (thanks so much for that by the way). It's an interesting study, but the number you quote is for all ages, not children (and includes a mistaken factor of 100 - 0.43 deaths per million that is quoted should be 0.000043%). For under 20s pre vaccine it was 0.7 deaths per million (which is 0.00007%). And look at the decline since vaccines were introduced - particularly in children. In babies (<1) it's gone from 8 deaths a year pre vaccine, to zero deaths a year in 2004-2007. In fact in all children under 19 (see Table 1 in the link Turquesa provided) there are now (2004-2007) basically no deaths due to chicken pox, down from 50/year in the 1990s pre vaccine. 

This is what makes me angry about the NHS (UK) policy to not vaccinate against this disease. I want to show this to my Doctor too! ;) However I think s/he would then bring up the increase in the death rates in older adults. I'm not sure what that's down too  - perhaps less deaths due to other diseases, but this is the justification the UK uses to not pay for this vaccine for British children. 

I love stats. Thanks again for the link. 

[Turquesa]

I’m not going to provide a detailed reply due to my request to keep this thread focused on the topic of questions to ask doctors about vaccines.  Are you referring to a margin of error?  If so, that would give us a *range* of 0.0000043% to 0.00000043%.  Doctors should be communicating those figures to patients and letting *parents* decide if those numbers should keep them up all night in fear.  I’m not accounting for the figure for children until I get a hold of more conclusive data; to date, Canadian public health officials are warning the public that chicken pox is 25 times more deadly in adults than in children.  http://www.halton.ca/cms/one.aspx?portalId=8310&pageId=9602wish  Again, if you to pursue this discussion, please consider a spin-off thread so that this one doesn’t get bogged down in tangential discussions.  Thanks. 

[Taximom5]

Originally Posted by slmommy 

General -

; ">In addition to broad liability protection, the 1986 Law also provides another shield to manufacturers under federal law. (48) The 1986 Law permits them the right to not disclose known risks to parents or guardians of those being vaccinated.

I'm in shock; I did not know that.

So much for informed consent.

[prosciencemum]

It might help to see these things through the eyes of your Doctor. And interesting post here: http://www.psmag.com/health/changing-parental-attitudes-on-child-vaccinations-41350/ by a pediatrician (Dennis Rosen) on how he approaches conversations about vaccines with concerned parents. 

Off topic: 

Originally Posted by Turquesa 

I’m not going to provide a detailed reply due to my request to keep this thread focused on the topic of questions to ask doctors about vaccines.  Are you referring to a margin of error?  If so, that would give us a *range* of 0.0000043% to 0.00000043%.  

No I just mean you made a mathematical error. An incidence of  0.43 in 1 million is 0.000043% which is 100 times bigger than the percentage you gave. And also doesn't refer only children, but children plus adults - and I thought this was a thread about childhood vaccinations. 

[purslaine]

varicella - what do you think of the idea that shingle is on the rise, and among younger people, due to the fact that chicken pox is not so common anymore, and people are not having their immunity boosted through exposure?  

[prosciencemum]

Originally Posted by kathymuggle 

varicella - what do you think of the idea that shingle is on the rise, and among younger people, due to the fact that chicken pox is not so common anymore, and people are not having their immunity boosted through exposure?  

 That's a great question to ask a Doctor. I wonder if in the US they would recommend you get the varicella vaccine too. Argument against introducing varicella for children in the UK seems to be the cost to the NHS of having to vaccinate the entire adult population at the same time. 

[slmommy]

Originally Posted by prosciencemum 
 

 and I thought this was a thread about childhood vaccinations. 

I think OP just intended for this thread to be a list of questions to ask your pedi, not the validity of certain questions, that would be the call for readers and/or their hcps to make. 

[Taximom5]

Originally Posted by prosciencemum 

It might help to see these things through the eyes of your Doctor. And interesting post here: http://www.psmag.com/health/changing-parental-attitudes-on-child-vaccinations-41350/ by a pediatrician (Dennis Rosen) on how he approaches conversations about vaccines with concerned parents. 

Interesting post by Rosen.  He emphasizes changing parental attitudes, not on doing ANYTHING to reduce the number of severe adverse reactions to vaccines.  The only study he mentions is Wakefield's; not once does he mention any of the plethora of studies and case reports linking vaccines to developmental delays, tics, speech disorders, autoimmune disorders, etc.  He doesn't say a word about vaccine reactions. He does tell a heart-rending story of watching two teens die of diphtheria.  What about the heart-rending story of losing a child's development and health to a vaccine reaction?

He doesn't even admit that there's a possibility.

He also claims that when he Googled "MMR vaccine autism,"  2 of the first 10 links supported the connection.  

Funny, I just tried it myself. I'm glad I did. There were only 2 links supporting a vaccine-autism connection in the first 2 pages. The 9th link was a news report about another child,  "Julia," who, in 2009, was compensated for vaccine-induced encephalitis, and then formally diagnosed with autism (directly caused by the encephalitis) in 2010.  Her mother knew enough to keep the word "autism" out of "Julia's" records until the case was decided:  "after Julia’s last neuro appointment when her dr said she had signs of autism. I didn’t want that “word” in her records until Julia’s case was decided."

The 16th link is to a Reuters news article from 2002, about Bush asking federal court to seal all documents relating to MMR vaccine injury cases.

One has to wonder why Rosen wouldn't want parents to see these links.

So I guess one might also want to ask their doctor what (s)he thinks of the fact that the government asked federal court 10 years ago to seal all documents relating to MMR vaccine injury, and how that might relate to general knowledge of "known" risks to that and other vaccines.

[Turquesa]

A couple of things:

1. This is a thread for people of all ages getting vaccinations.  Adults get vaccines, too, and are just as entitled as children to informed consent.

2. I checked out the link again and made the correction.  Thanks for pointing it out Prosciencemum.  In the pre-vaccine era, the mortality rate for CP was 1 in 43 million, 0.0000043%, or roughly 5 people annually in the U.S., (based on a 1990 population of 248,545,805 people). 

3. For a third time, the purpose of this thread is to contribute questions to ask doctors about vaccines, (or to make any related clarifications).  Please take any side conversations to spin-off threads so that we can stay can stay focused.  Thank you. 

4. PSM, in the interests of focusing, my only comment on your link is that we already hear things "thruogh the eyes of a doctor."  All.  The.  Time.I started this thread because it's darn time they started hearing from us. 

Edited by Turquesa - 5/17/12 at 5:04pm

[slmommy]

DTaP -

In what situations (especially when delaying), are 3 or 4 initial doses of DTaP necessary? Evidence in Daptacel product insert seems to suggest efficacy is just as good at 3 doses as 4 doses, as per a study done with Swedish infants who only received 3 doses at 2,4,6 months and acheived efficacy level equivalent to American infants receiving 4 doses at 2,4,6, 15 months.

BCG - 

Can someone who has had bcg be checked with skin test later on in life? Do you know at what rate the BCG vax could cause false positives? What is the preferred method of testing for TB in someone who has had BCG?

Edited by slmommy - 4/29/12 at 5:34pm

[Turquesa]

Just updated this with your questions, slmommy.  Sorry.  I need to be more vigilant about this. 

[marymoo86]

My question is why do we need the varicella (CP) vaccine when it is has been deemed a total flop?

http://www.sciencedirect.com/science/article/pii/S0264410X12007761

The universal varicella (chickenpox) vaccination program now requires a booster vaccine for children and an HZ vaccine to boost protection in adults. However, these are less effective than the natural immunity that existed in communities prior to licensure of the varicella vaccine. Hence, rather than eliminating varicella in children as promised, routine vaccination against varicella has proven extremely costly [60], [62] and [168] and has created continual cycles of treatment and disease.

[MichelleZB]

So, did you ask your doctor these questions? What did they say?

[purslaine]

Originally Posted by marymoo86 

My question is why do we need the varicella (CP) vaccine when it is has been deemed a total flop?

http://www.sciencedirect.com/science/article/pii/S0264410X12007761

The universal varicella (chickenpox) vaccination program now requires a booster vaccine for children and an HZ vaccine to boost protection in adults. However, these are less effective than the natural immunity that existed in communities prior to licensure of the varicella vaccine. Hence, rather than eliminating varicella in children as promised, routine vaccination against varicella has proven extremely costly [60], [62] and [168] and has created continual cycles of treatment and disease.

  Thanks for posting that article - very interesting read!