IOM to Public: Childhood Vaccine Schedule is Safe

Hey parents: if you've been taken in by anti-vaccine discussions on the internet, you might want to look at the newest report from the Institute of Medicine.  After a lengthy and thorough review of the evidence, the IOM issued a report last week that found that the current childhood immunization schedule in the United States is safe.

The IOM committee specifically looked for evidence that vaccination is linked to "autoimmune diseases, asthma, hypersensitivity, seizures, child developmental disorders, learning or developmental disorders, or attention deficit or disruptive disorders", including autism.  Their finding: no evidence suggests a link to any of these conditions.

The motivation for the report is the growing incidence of parents who worry that there are "too many, too soon" - a catchphrase that was the basis of an anti-vaccine campaign led by Generation Rescue and its spokesmodel, Jenny McCarthy.  This concern, which sounds reasonable on its face, never had any evidence to support it.

Anti-vaccine activists have pointed out, correctly, that the number of vaccines has increased significantly over the past several decades.  The current schedule has as many as 24 immunizations in a child's first two years, and up to five injections in a single visit.  The reason for this is simple: the scientific community has developed vaccines against a growing number of childhood illnesses.  As a result, many diseases that used to infect millions of children each year, killing or permanently injuring thousands of infants and toddlers, have almost disappeared from modern societies.  This is a good thing.

Many parents have been convinced to "slow down" vaccines after hearing advice from self-proclaimed vaccination authorities, such as "Dr. Bob" Sears.  Sears has published his own alternative vaccine schedule (which he apparently just made up - he certainly didn't do a scientific study) and whose has gotten rich selling his book and offering other advice.  Journalist Seth Mnookin calls Sears "a first-rate huckster."

Noted vaccine expert Paul Offit, in a peer-reviewed article in the journal Pediatrics four years ago, explained how Sears ignores all the science on vaccine safety, sometimes simply replacing objective evidence with his own "facts." Offit also called out Sears for his advising parents not to vaccinate their kids, but then not to tell their neighbors:

“I also warn [parents] not to share their fears with their neighbors, because if too many people avoid the MMR, we'll likely see the diseases increase significantly.” [wrote "Dr. Bob" Sears]  

In this astonishingly selfish comment, Sears admits that herd immunity works, but then says don't tell your neighbors, because then their kids might get sick and infect your unvaccinated kids.

Offit's article is a thorough, point-by-point rebuttal of Sears' numerous claims, many of them either misleading or downright false.  I highly recommend it.  Or  read the IOM's report online, for free.  Don't waste your money on Dr. Bob's book.

Let's hope all parents will follow the recommended vaccine schedule and ignore the voices of fear and unreason who are trying to scare them.  If you're still in doubt, read the heartbreaking story, from just a few days ago, of 7-year-old Alijah Williams in New Zealand.  Alijah's well-educated parents thought they were doing the right thing by withholding vaccines, after reading some scary material on the internet.  Alijah was infected with tetanus last year and fought it for months, nearly dying in the process.  His recovery will take 12 months, during which he will have to re-learn how to eat and walk on his own.  His parents have now become activists trying to spread the word among their community that infections are the real threat - not vaccines.

Anti-vaccination propagandists help create the worst whooping cough epidemic in 70 years

The great northwest of the U.S. is known for its natural beauty.  It's also a high-tech region with a highly educated public - not exactly the kind of place one would expect to fall for the anti-science rhetoric of the anti-vaccine movement.

But it has.  The anti-vaxxers have convinced a frighteningly high number of parents in Washington State to withhold vaccines from their children.  A story in The Seattle Times last year reported that 

"Washington [state] parents are choosing not to vaccinate their kindergartners at a rate higher than anywhere else in the country."  

This despite the fact that the Bill & Melinda Gates Foundation (formed by the founder of Microsoft, which is headquartered in Seattle) is one of the world's leading sponsors of vaccine research.  

When the vaccination rates drop, everyone becomes more vulnerable to infectious diseases.  When more than 90% of the population is vaccinated, we have "herd immunity" - this means the disease can't spread because there aren't enough susceptible people in the community.  So the high rate of vaccine refusal in Washington makes it easier for whooping cough (and other diseases) to spread.

The media has been complicit in spreading some of the anti-vaccine misinformation.  Sometimes it comes straight from the media itself, such as the credulous, anti-science, anti-vax CBS reporter Sharyl Attkisson. Other times it comes from talk shows, magazines, or even airline advertisements that provide a platform for anti-vax celebrity doctors such as Jay Gordon (who gained fame as Jenny McCarthy's son's doctor) and "Dr. Bob" Sears, who has published his own "alternative" vaccine schedule in a book filled with anti-vaccine nonsense.  These characters continue to claim, at every chance they get, that vaccines cause autism (as Gordon has said, repeatedly), or that they cause other harms, despite overwhelming evidence to the contrary.  They use their medical degrees and their faux concern "for the children" to frighten parents into keeping their kids unvaccinated.

And now we learn that the U.S. is in the midst of the worst whooping cough epidemic in 70 years.  One of the most hard-hit states is Washington, which the CDC just announced (on 20 July) has suffered 2,520 cases so far this year, a 1300% increase over last year.  This is the highest number of cases reported in Washington since 1942.  This plot of the number of cases this year compared to last year shows the dramatic rise in infections:

The figure above shows the number of confirmed and probable pertussis cases reported, by week of onset in Washington, during January 1, 2011-June 16, 2012.  Source: Morbidity and Mortality Weekly Report, U.S. Centers for Disease Control and Prevention.

Making things worse, it seems, is an increase in cases among children aged 13-14.  Children get a booster shot at age 11-12, but the new outbreak indicates that the effectiveness of the booster may not last very long.  The dramatic increase in whooping cough this year also suggests that the bacterium that causes it, Bordetella pertussis, is mutating to make the vaccine less effective.  Nevertheless, the CDC emphasizes: 

"Vaccination continues to be the single most effective strategy to reduce morbidity and mortality caused by pertussis. Vaccination of pregnant women and contacts of infants is recommended to protect infants too young to be vaccinated."

This good advice is seriously undermined when misinformed doctors such as "Dr. Bob" Sears directly advise pregnant women not to get the whooping cough vaccine, as he did in the Huffington Post. (Hint: it's a good rule to be very skeptical of celebrity doctors who go by their first name.)

I should also point out that whooping cough is a national problem, not just Washington State's.  The U.S. has had over 17,000 cases this year, putting it on track for the worst year since 1959.  The highest rate of infection in the nation is in Wisconsin (which has also been hit hard by anti-vaccine effects), followed by Washington and Montana. 10 deaths have been reported, mostly in infants who were too young to be vaccinated.  For all this, we can thank the anti-vaccination movement.

Should a doctor fire an anti-vax patient?

The anti-vaccination movement continues to grow, despite the retraction and thorough discrediting of the 1998 scientific study that spurred much of its growth.  The stubborn persistence of anti-vaxxers shows how difficult it is to dispel misinformation once that information is out there, even after dozens of new studies and millions of dollars in research that demonstrate that vaccines are safe.

One of the most dangerous trends is the growing number of parents who refuse to vaccinate their kids, or who choose "alternative" vaccine schedules, such as the one promoted aggressively by Robert Sears (who goes by "Dr. Bob").  Sears appears to have simply invented this alternative schedule without bothering to conduct any scientific studies, in part to promote sales of his 2007 book, The Vaccine Book: Making the Right Decision for Your Child.  Vaccine expert Dr. Paul Offit explained, in a 2009 article in the journal Pediatrics, why Dr. Sears' schedule was a very poor choice for children and for the public health.  After thoroughly dismantling Sears' anti-science positions, Offit concludes, "Sears has a poor grasp of the scientific method."  That's an understatement.

Other doctors, perhaps jealous of all the attention that Sears has gained through his anti-vaccine writings and television appearances, have created their own alternative vaccine schedules.  One of them, Donald Miller, even goes so far as to say that vaccines cause childhood cancer, despite the complete lack of evidence for this wild claim.  Somehow Sears, Miller, and others like them have managed to convince many parents that their children don't need vaccines.

In response to parents who don't want to vaccinate, many of whom show up with Dr. Bob's schedule in hand, pediatricians have struggled to find an effective response.  Parents can be utterly convinced by the misinformation they find on the Internet, which is all too easy to find.  (For example, Googling "vaccine" brings up the National Vaccine Information Center, a hotbed of anti-vaccine propaganda and pseudoscience, on the first page of hits.)  By the time parents arrive with their babies for the first vaccine, convincing them to change their minds can be nearly impossible.

Perhaps in frustration, doctors have started to "fire" their patients if they refuse to vaccinate.  As reported by Shirley Wang in The Wall St. Journal last week, 20-30% of doctors in two different surveys, in Connecticut and the Midwest, reported having to kick patients out of their practices because of vaccine refusal.  These numbers have roughly doubled over the past ten years, according to the American Academy of Pediatrics.

Is firing a patient the right thing to do? It's a difficult question.  On the one hand, doctors should do everything they can to make sure kids are vaccinated.   If a doctor kicks a parent out, that parent may find another doctor who doesn't insist on vaccinating children, which ultimately harms the children.  Doctors have to spend more time educating parents about the tremendous benefit of vaccines, about the very strong evidence (based on tens of millions of doses) for vaccine safety, and about the frightening consequences of infection with meningitis, hepatitis, measles, polio, and other vaccine-preventable diseases.

On the other hand, unvaccinated children bring diseases into the pediatrician's office, where they can spread them to other children.  Some of these other children are too young to be vaccinated, and childhood infections can be extremely dangerous, even fatal, in the very young.  From this perspective, "firing" a patient might be the only responsible action, after first trying to convince the parents to vaccinate.  I know that I wouldn't want to bring my child to a doctor's office where unvaccinated children were in the same room.

I understand how nervous a parent can be about vaccinations.  I will never forget the day my older daughter got her first vaccine: the needle looked huge compared to her tiny leg, and she screamed when the doctor gave her the shot.  But she was fine a few minutes later, and she'll be protected against a dangerous infection for her entire life.  Vaccines have been so successful at eliminating childhood infections that parents no longer see these infections as a threat.  Ironically, the very success of vaccines has allowed the anti-vaccine movement to sway so many people.

Doctors may have to keep firing the parents of their young patients, but I hope they'll first make every effort to educate them.  They need to explain that vaccines do not cause autism, nor do the ingredients in vaccines, and that scientific studies involving hundreds of thousands of patients support these conclusions.  They should also explain that many of the anti-vaccination claims on the Internet started when Andrew Wakefield published one small study of 12 patients, now retracted, claiming a link between the MMR vaccine and autism.  Investigations later revealed that he was paid by lawyers to recruit patients for a lawsuit against vaccine makers, that he didn't reveal these payments to his co-authors or the patients, and that he manipulated the data.  Since then, the anti-vaccine movement has exploded and we've experienced multiple outbreaks of measles, mumps, and other illnesses linked directly to unvaccinated children.

Doctors interviewed by the Wall St. Journal reported that they had convinced at least some parents to follow the recommended vaccine schedule.  Perhaps that's the best we can hope for.  If we're going to avoid a return to the era when children routinely died from infections, we must keep trying.

Whooping cough in California: deaths caused by the anti-vaccination movement

California is suffering the worst epidemic of pertussis, or whooping cough, in 60 years, with over 5,200 cases already, the most since 1950. Nine babies have died, all of them too young to receive the vaccine. Michigan is also reporting a serious outbreak, with over 600 cases so far this year. The deaths of the infants in California are tragic, and what’s more tragic is that some of them almost certainly could have been prevented if more people had been vaccinated.

The pertussis vaccine, called DTaP (diphtheria, tetanus, and pertussis) has been responsible for a dramatic drop in whooping cough in recent decades. It isn't 100% effective, but its effectiveness relies in part on “herd immunity”: if enough people are immune to the bacteria, then even if someone gets sick, the disease cannot easily spread through the community. This is especially true for very young infants, who are too young to be vaccinated and whose immune systems are not yet strong enough to defeat the bacteria on their own.

Unfortunately, it’s not a coincidence that California is the center of the new pertussis epidemic. Vaccination rates among adults in California have been dropping in recent years, largely due to the influence of anti-vaccination zealots such as Jenny McCarthy and groups such as Age of Autism. Anti-vaccination sentiments seem to strike a chord with relatively well-educated segments of the population – the same people who favor organic food and want to use “natural” products as much as possible. Anti-vaxers appeal to this group by arguing that vaccines are unnatural, and that the body’s own immune system can be “boosted” by various natural treatments. Appealing though this may sound, it has no basis in science. California makes it easy for parents to claim exemptions from the required vaccinations for their children, and exemptions have more than doubled since 1997, according to the L.A. Times.

Among the anti-vaccinationists who deserve blame for the current pertussis outbreak is “Dr. Bob” Sears, a kindler, gentler anti-vaxer who claims (like many of them) to be in favor of vaccines, but only under his own, unscientific terms. He stated flatly in the Huffington Post (a hotbed of medical misinformation) recently that pregnant women should not get the DTaP vaccine. But as Dr. Paul Offit tells us in a tragic story, refusing the vaccine can lead directly to the death of an infant. Dr. Bob is just wrong. I should add that Sears has written two books on vaccines and autism, promoting his misguided “alternative” vaccine schedule (see this article in Pediatrics about that) and his rather naive theories about the rise in autism diagnoses.

Everyone should have their children vaccinated. On top of that, in order to maintain herd immunity, most of us should get the pertussis booster shot if we haven’t had one in the last ten years. That’s what vaccine expert Paul Offit recommends, and I’m planning to follow his advice myself. It won’t take long, and it might save a life.