Starting fresh - a pediatrician's perspective - Page 3

[anj_rn]

Originally Posted by rahrahgobg 

I have a question.

I am considering giving the DTaP to my children.  My oldest was vaccinated until the MMR vaccine showed up in the schedule.  My 2nd child had 2 shots.  The Hep B in the hospital at day one and the 2nd shot in the series that had the Hep B in it.  My 3rd has not had any vaccines.  My youngest is 4, almost 5.  My second child is special needs, and I am a little paranoid about giving him shots.  I am not saying vaccines gave him his issues, but I am not ruling it out.  I will never know since he was vaccinated on day one.

If I wanted to give my kids a DTaP, I want to be sure they get only what is needed.

My kids are 4, 6 & 8.

Do they need the 3-series shot, or can they have the Tdap as a one-shot series?

How long does it take that shot to become effective to protect against the disease?

Thank you.

Dtap is a 5 dose series with usual doses at 2mos, 4 mos, 6 mos, 18 mos, and 4 yrs.  You drop one dose if you do not start the series until the child is 4.  You your oldest should have had 3 shots, and would need 2 more (one Tdap and one Td since they do not do DTaP after age 7).  

I am unclear as to what vaccine your 6 yr old had, but either it was a combo vax with Dtap, and you have 4 doses left, or you are starting new, and need 4 doses.

Your youngest would need 4 doses.

All would have a booster due at 11 yrs of age (per the CDC guidelines).

I am curious as to why you chose the DTap out of all the vaxes.  We selectively vax & are on a delayed schedule, but I am always interested to know how others choose what to vax for and when to do it.

[mgrella]

To address the "most important" issue, everyone will have a different answer.  In some ways it's apples to oranges, just like "what's more important, wearing your seat belt or or exercising regularly?"  Both can be lifesaving but hard to compared the "relative goodness".  This also depends hugely on your age and life situations (childed or childless, with elderly parents or not, teen or older parent, etc).  Those with older kids won't care as much about a vax that saves many newborn lives; those with only infants will not likely care as much about sexually transmitted infection prevention. 

My individual point of view is that lifesaving vaccines are most important, modified by one's chance of getting that disease and the chance of cure.  As another example: a vaccine for HIV if developed would be #1, because although prevalence (in the US) is low, death rate (for now) is 100%.  Hep A vaccine prevents a fairly common disease but almost no deaths and few hospitalizations, so I would rank that at bottom.  None of the vaccines in the routine US schedule are considered (by me) to be experimental or dangerous, so I will be avoiding any discussions regarding relative safety.

So against my better judgement, here goes: 

HiB (can be fatal or disabling and used to be a frequent cause of meningitis, blood infection, deafness and seizure disorder prior to vax)

Strep pneumoniae (aka PCV13 or Prevnar; similar to above)

MMR (because measles is wildly contagious and can be fatal; in some states we are approaching dangerously low levels of herd immunity)

DTaP/Tdap (in the US mostly for pertussis prevention, because pertussis can kill newborns)

Influenza (very contagious, 30,000 deaths per year in US, vaccine moderately effective)

Hep B (once acquired, no cure and can lead to liver cancer and/or cirrhosis)

Polio - still around and very disabling

Varicella (very common, very contagious, hospitalization rate ~1%, death rate ~1/10,000 in the US)

HPV - VERY common, can lead to cervical (and anal and throat) cancer

Menigococcal (MCV) - less common but very serious and sometimes fatal

Rotavirus (prevents a very common but rarely fatal (in the US) disease

Hep A (fairly common but rarely fatal or disabling)

How's that for a start?

[prosciencemum]

Just wanted to say welcome to "Mothering" and thanks for trying to do this. I hope you don't get frustrated and give up too quickly, although I wouldn't blame you if you did. ;) 

[mgrella]

Thanks!!

MJG

[AmandaT]

Originally Posted by mgrella 

  As another example: a vaccine for HIV if developed would be #1, because although prevalence (in the US) is low, death rate (for now) is 100%.  

Uhhh... What?!? Did you mean to say AIDS? The death rate for HIV is certainly not 100%

[mgrella]

Yes, it is.  Everyone progresses to AIDS over time.  There is currently 1 (that is ONE) long-term survivor with no onset of AIDS after many years.  Everyone else dies.  Period. 

[AmandaT]

It's more than just Magic Johnson. Some simple googling is showing me about 25% of people have no transition for 15 years and 10% of people are able to live indefinitely with HIV as a chronic manageable long-term illness. 10% is not a high number, but it is certainly much higher than zero. 

[Bokonon]

Originally Posted by mgrella 

 None of the vaccines in the routine US schedule are considered (by me) to be experimental or dangerous, so I will be avoiding any discussions regarding relative safety.

So you only want to only talk about how important and lifesaving vaccines are, in a forum for delaying and selective vaccination?  

Dismissing the topic of relative safety is very disturbing and something that leads many parents to distrust the medical establishment.  It's a line we're fed over and over again, despite glaring evidence to the contrary.

[mgrella]

Survival long-term, yes.  Indefinitely, no.  Although it may take 20 or 30 years, everyone dies from HIV. 

Not sure why you mention Magic Johnson (I didn't) but with limitless funds, yes, progression can be put off for a long time.  If you have access to those funds, let us all know. 

And by the way, HIV being "chronic" and "manageable" after 30 years is deplorable - humanity should be ashamed of itself.

[AmandaT]

Indefinitely, yes. That is why I used that word and not "20 to 30 years". 

I mentioned Magic Johnson because he is the go-to long term survivor of HIV and you stated only one existed anywhere. 

But I agree, it is deplorable. And OT.

[mgrella]

Everyone here has their own perspective - mine is to accept the science done for generations that has saved countless lives and prevented countless disabilities and move forward. 

If you know no one who had polio and is now crippled, great - I do.

If you know no one who had meningitis as a child and is now deaf or epileptic, great - I do.

If you would like to ignore the science and bring your unvaccinated kids to the countries that still have polio and measles and take your chances, feel free. 

Everyone here likes to ignore the fact that we live in a country where many infectious disease rates are the lowest in the world BECAUSE OF VACCINES. 

Without the vaccines that you and/or your peers received as children, probably 25% of us would be dead or disabled.  Read your history or ask your parents if they are old enough to remember epidemics of polio.

Proclaiming one's kids as vax-free means climbing onto the backs of the 95-99% of people who get vaccines and prevent outbreaks AND SAVE YOU by providing herd immunity.  Until you want to tempt fate and expose your unvaccinated kid to polio or measles in an endemic country, yes, I'll talk about lives saved and disabilities prevented.  "Relative safety" as you term it is exactly what you should care about.  Every action one takes, every day of one's life, involves "relative safety".

[AmandaT]

Originally Posted by mgrella 

Everyone here likes to ignore the fact that we live in a country where many infectious disease rates are the lowest in the world BECAUSE OF VACCINES. 

This is not a fact. Sanitation has done much more for disease rates than vaccines ever could. Please post a study that looks only at what vaccines have done, without better access to clean water, sanitation, and better medical care to back up your assertion. 

As for the rest of your post - maybe you should look at the user agreement.

[kathymuggle]

Originally Posted by mgrella 

Everyone here has their own perspective - mine is to accept the science done for generations that has saved countless lives and prevented countless disabilities and move forward. 

If you know no one who had polio and is now crippled, great - I do.

If you know no one who had meningitis as a child and is now deaf or epileptic, great - I do.

If you would like to ignore the science and bring your unvaccinated kids to the countries that still have polio and measles and take your chances, feel free. 

Everyone here likes to ignore the fact that we live in a country where many infectious disease rates are the lowest in the world BECAUSE OF VACCINES. 

Without the vaccines that you and/or your peers received as children, probably 25% of us would be dead or disabled.  Read your history or ask your parents if they are old enough to remember epidemics of polio.

Proclaiming one's kids as vax-free means climbing onto the backs of the 95-99% of people who get vaccines and prevent outbreaks AND SAVE YOU by providing herd immunity.  Until you want to tempt fate and expose your unvaccinated kid to polio or measles in an endemic country, yes, I'll talk about lives saved and disabilities prevented.  "Relative safety" as you term it is exactly what you should care about.  Every action one takes, every day of one's life, involves "relative safety".

This is not "starting fresh" as your title proclaims.

It is pretty much what I have heard out of most pro-vaxxers over and over again.

Too bad - it would be cool to pick the brain of a sel/delayed doctor.

Oh, and the 25% is total crap.  I would like to know how you arrived at that figure.  The CDC states 1% of those who get Polio have serious complications.http://www.cdc.gov/vaccines/vpd-vac/polio/in-short-both.htm.  Measles death rate - 1 in 1000.  I could go on.

Edited by kathymuggle - 9/18/12 at 6:31pm

[Ktietje85]

Well, now I just have to ask....

In the WHO's position paper on rotavirus, there is a study they cite.  It shows that the vaccine has a 95%+ "efficacy" rate in the U.S. (where rotavirus is not epidemic and rarely serious) but less than 50% "efficacy" rate in Malaysia, where it IS epidemic.  They don't seem to understand that since the same vaccine was used, the vaccine itself is not the variable.  There cannot be different "efficacy" rates for the exact same vaccine.

What that study actually shows is that the vaccine doesn't really work.  The major differences between the U.S. and Malaysia are access to proper nutrition, clean water, and medical care.  These are the factors that reduced the rates and seriousness of these diseases, not vaccines.  That study makes it glaringly obvious.

So if that's true, how can you state that vaccines are definitely responsible for reduction in VPDs?  And what do you make of that study?

[emma1325]

Originally Posted by mgrella 

My point was that a religious exemption is NOT whatever you like; your religion is NOT the same as your personal beliefs.  This is not a "make your own ending" book.  You are referring to a philosophical set of beliefs and that is NOT the same as a religion. 

If a state allows for a philosophical objection then there would be no issue.  As you quoted,

If there is a religious exemption, the parent/guardian must give the facility/school a signed and dated notarized statement or affidavit stating that immunizations are against their religious beliefs.

This has NOTHING to do with whether one's child has a "bad reaction" to a vaccine - either your RELIGIOUS beliefs allow for vaccinations or they do not.

The larger issue here is that states allow medical exemptions when the risk to a patient of receiving vaccinations is deemed to be greater than the risk to their contacts of them contracting and spreading a disease.  In those states where religious and/or philosophical exemptions are allowed, the state has decided that these freedoms are of greater importance than the public health risk.   

Again, a "bad reaction" is neither.  Period.

Please do not attempt to pursue this with me.  I'm thrilled to have a discussion with anyone and everyone discussing medical and scientific strategies, but you are trying to equate a personal decision made emotionally with religion (NOT) and/or medicine (again, NOT).  Many reactions can be avoided with pretreatment or managed with a predetermined strategy.  Your advice is instead to make a rash decision which might lead to a VPD that could damage a child (and then whom would YOU blame)? 

Greetings, Doctor!

I believe there are a couple of things you should come to terms with.  First of all, most states offer religious exemptions but do NOT require that parents actually belong to said religion, or that they provide any proof of a religion in order to file religious exemption.  Therefore, a parent can most certainly decide based on a "bad reaction" to delay or discontinue further vaccination and file a religious exemption.  Whether or not you believe that is an honest course of action is inconsequential; it is a perfectly legal option.

Secondly, exemptions are in place because there is no proof that a lack of immunity to the myriad of diseases we currently vaccinate for is dangerous to the public.  If herd immunity were the true motives behind vaccine legislation, then titer testing would be required of all children - not vaccines.  Of course, immunity is not the goal - shot status is, since shot status pads the bottom line, not immunity.  Public health is not what vaccine lobbyists are after, and I believe you and I both know that.  Your suggestion in the above quote that the child in question, who has previously experienced adverse vaccine reactions, could theoretically be exposed to, contract, and become damaged from a VPD seems to ignore the fact that vaccines hold very real, sometimes very serious risks.  I believe that what some doctors are more afraid of is that parents will stop vaccinating and see that their children are just as healthy as they were with vaccines, if not more so.  This would be a very difficult lesson for society to learn - that they have been misled their entire lives about the necessity of risky vaccines, the risks of which no one truly understands since the safety studies and reporting system are so flawed.

Thirdly, doctors who express the kinds of views you seem to have turn families like mine off and ultimately lose good patients.  I say this with the genuine hope that you examine your views and the manner in which you present them, because people like me aren't going away.  

[rlneub]

You imply that parents rely on others for herd immunity. So in light of this statement, I would like to know how you explain herd immunity based on the following studies? Are these studies wrong is there another reason they are discounted?

http://www.ima.org.il/imaj/ar06may-2.pdf

Pertussis is considered an endemic disease, characterized by an epidemic every 2–5 years. This rate of exacerbations has not changed, even after the introduction of mass vaccination – a fact that indicates the efficacy of the vaccine in preventing the disease but not the transmission of the causative agent (B. pertussis) within the population [19].

http://www.cdc.gov/ncidod/eid/vol6no5/pdf/srugo.pdf

The effects of whole-cell pertussis vaccine wane after 5 to 10 years, and infection in a vaccinated person causes nonspecific symptoms (3-7). Vaccinated adolescents and adults may serve as reservoirs for silent infection and become potential transmitters to unprotected infants (3-11). The whole-cell vaccine for pertussis is protective only against clinical disease, not against infection (15-17). Therefore, even young, recently vaccinated children may serve as reservoirs and potential transmitters of infection.

http://pediatrics.aappublications.org/cgi/content/full/104/6/1381

Case definition has been particularly problematic in all of the recent DTaP vaccine efficacy trials. For uniform comparative purposes a case definition was suggested by a WHO expert committee.39 This definition required 21 days of paroxysmal cough plus laboratory confirmation of pertussis in the subject or household contact. There are 2 problems with this definition. The first is that a substantial number of B pertussis infections in unvaccinated children are mild and would not meet the case definition. The second is that all pertussis vaccines tend to modify duration and severity of disease rather than completely preventing illness.18,2326-29,35,36,40 Therefore, the WHO definition has made all vaccines look better than they are and it has tended to obscure differences between vaccines.

http://www.ima.org.il/imaj/ar06may-2.pdf

Pertussis is considered an endemic disease, characterized by an epidemic every 2–5 years. This rate of exacerbationshas not changed, even after the introduction of mass vaccination – a fact that indicates the efficacy of the vaccine in preventing the disease but not the transmission of the causative agent (B. pertussis) within the population [19].

http://www.ncbi.nlm.nih.gov/pubmed/16294220

Whooping cough is considered a childhood disease, although there is growing evidence that children are infected by adult carriers. Additionally, increasing numbers of vaccinated adults are being diagnosed with Bordetella pertussis disease. Thus it is critical to understand how B. pertussis remains endemic even in highly vaccinated or immune populations. Here we used the mouse model to examine the nature of sterilizing immunity to B. pertussis. Antibodies were necessary to control infection but did not rapidly clear B. pertussis from the lungs. However, antibodies affected B. pertussis after a delay of at least a week by a mechanism that involved neutrophils and Fc receptors, suggesting that neutrophils phagocytose and clear antibody-opsonized bacteria via Fc receptors. B. pertussis blocked migration of neutrophils and inhibited their recruitment to the lungs during the first week of infection by a pertussis toxin–dependent (PTx-dependent) mechanism; a PTx mutant of B. pertussis induced rapid neutrophil recruitment and was rapidly cleared from the lungs by adoptively transferred antibodies. Depletion of neutrophils abrogated the defects of the PTx mutant. Together these results indicate that PTx inhibits neutrophil recruitment, which consequently allows B. pertussis to avoid rapid antibody-mediated clearance and therefore successfully infect immune hosts.

http://www.ncbi.nlm.nih.gov/pubmed/22423127

"Our unvaccinated or undervaccinated population did not appear to contribute significantly to the increased rate in clinical pertussis." and "amongst the 58 cases of pertussis in children aged 10 - 12, 95% had received 5 or more doses of pertussis vaccination ... 18 of these had received their sixth booster prior to onset of disease" "Surprisingly in the 2 - 7 and 8 - 12 age groups there was no significant difference in attack rates between the fully vaccinated and under and unvaccinated" Yet.....vaccine effectiveness was stated as 41% for 2 - 7s, and 24% for 8 - 12s.

[marymoo86]

I would like to know your thoughts on adjuvants used in vaccines that do not have safety studies and are neurotoxins like aluminum.  

[Alenushka]

I have worked with people who have post polio syndrome. It is sad and horrible.

My BF had patient ones who survived tetanus. This patient paid a high price.

I have colleague who is sterile because of mumps.

I had anafilactic shock reaction to flue vaccine. Then I was not vaccinated or got any boosters for many years. I caught mumps. It was so horrible. I was in undesirable pain and lots  a lot of weight.

My case of chicken pox was so bad that I had to be restrained at night.

When I got to US I was tested. I am allergic to thermasol. I got vaccinated for everything I could with preservative free vaccines.

I would rather have inflicting shock again rather than one of those "benign" VPDs.

My pedi listened to my concerns. We had somewhat modified Cheslie with the first child. He was premedcatated with Benadryl. All went well even thought I was super paranoid about autism.

My friend has autistic child. She never vaccinated him  until now but she is doing it now. The child is 7 and vaccination are now making his autism any worse but at least now she does not have to worry about the VPDs as much

[Bokonon]

Originally Posted by Alenushka 

I would rather have inflicting shock again rather than one of those "benign" VPDs.

Would you rather have your child suffer anaphylactic shock and/or seizures?

These anecdotes are all fine and good, if you are also willing to accept others' anecdotes about vaccine reactions.  From your posts in this forum, I don't see that.

[emma1325]

Originally Posted by Alenushka 

I have worked with people who have post polio syndrome. It is sad and horrible.

My BF had patient ones who survived tetanus. This patient paid a high price.

I have colleague who is sterile because of mumps.

I had anafilactic shock reaction to flue vaccine. Then I was not vaccinated or got any boosters for many years. I caught mumps. It was so horrible. I was in undesirable pain and lots  a lot of weight.

My case of chicken pox was so bad that I had to be restrained at night.

When I got to US I was tested. I am allergic to thermasol. I got vaccinated for everything I could with preservative free vaccines.

I would rather have inflicting shock again rather than one of those "benign" VPDs.

My pedi listened to my concerns. We had somewhat modified Cheslie with the first child. He was premedcatated with Benadryl. All went well even thought I was super paranoid about autism.

My friend has autistic child. She never vaccinated him  until now but she is doing it now. The child is 7 and vaccination are now making his autism any worse but at least now she does not have to worry about the VPDs as much

Does your friend routinely check her child's titers?  If not, why would she assume that vaccines induced immunity when it is known that vaccines have varying degrees of efficacy depending on the specific vaccine used and the individual receiving the vaccine?