"I just don't think his little body can handle all of those shots," the young mother said to me at her two-month-old son's check up. "Can't we wait until he is older? Or spread them out?"
As a pediatrician in the Bay Area, I have encountered a wide range of parental opinions when it comes to vaccines. On one end of the spectrum, there are super-eager parents who might ask to vaccinate early to get their little ones protected right away. On the other end, there are vaccine-refusers, prepared with anecdotes or personal beliefs to back their rationale for rejecting this basic preventive intervention.
The majority of parents fall somewhere in-between. Although, most are happy to adhere to the well-established schedule that the medical community recommends, some remain tentative for various reasons. Like the mother I describe above, these "vaccine-hesitators"—as pediatricians call them—sit on the fence between evidence-based recommendations from the medical community and fear mongering from the anti-vaccine movement. In the minds of many of these hesitators, the logical solution is to stake out a position that lies somewhere between the two opposing perspectives: a so-called "alternative vaccine schedule."
An Abundance Of Evidence
To be clear, the safety of vaccines, as well as the schedule in which they are given, has been extensively studied and is fully endorsed by both the American Academy of Pediatrics and the U.S. Centers for Disease Control and Prevention. In 2013, the Institute of Medicine conducted a thorough review and confirmed that the schedule is safe and effective.
Meanwhile, the safety and efficacy of the "alternative schedule" have not been studied. Nevertheless, we continue to see parents asking about alternative vaccine schedules. A Southern California pediatrician named Dr. Bob Sears popularized the alternative vaccine schedule through his 2007 publication, "The Vaccine Book: Making the Right Decision for Your Child."
By suggesting that parents can and should space out injections, over a longer period of time, Sears is essentially nurturing parents' fears and validating many myths about vaccine safety. That's despite the fact that no research provides evidence for the safety and efficacy of this extended schedule. It's no wonder that some parents—who only want what's best for their children—come into my office, questioning one of medicine's greatest achievements.
This issue returned to the public eye during a GOP debate in September, when Donald Trump spouted off about vaccines causing autism and further declared that they should be given in "smaller doses over a longer period of time." Even the two physicians on the stage—neurosurgeon Ben Carson and ophthalmologist Rand Paul—concurred with Trump's endorsement of this so-called "alternative vaccine schedule." These highly trained doctors thus wasted an opportunity to debunk the common misperception that alternative schedules are a reasonable compromise.
The Importance Of Conversation
This trend poses a real dilemma for physicians. How do we ensure that anxious parents receive the right information? In my experience, it often just takes a conversation. When the mother I describe above expressed hesitation, it prompted me to engage her.
"I know it sounds like a lot of shots, but yes, your son can handle them all," I said. "His little immune system is stronger than you think!"
I explained to her that from the time they are born, infants are bombarded with numerous bacteria and viruses in their environments, and their developing immune systems work hard to keep them from getting sick. The degree to which vaccines challenge an infant's immune system is miniscule in comparison, I said, and many studies have shown that vaccines are just as safe and effective when they're given concurrently as they are when given separately.
The young mother remained apprehensive. "It's just, he's so young," She said. "Can't we wait until he's a little older? I've heard that some people spread them out."
I had to choose my words wisely. I realized that with her trepidation, my words could tip the mother's decision in either direction. "I don't recommend waiting until he is older," I said, "In fact, it's because he's so young that I want to protect him from vaccine-preventable diseases as soon as possible."
Infants are at much higher risk of developing a serious invasive infection than older children or adults. This is why we get started when they are so young — to protect them when they need it most. This is also why pediatricians recommend against spreading vaccines out. When parents deviate from the standard vaccine schedule, they prolong the period of defenselessness during which infants and children could be afflicted with life-threatening, vaccine-preventable diseases. They also might miss some vaccines, either by accident or by choice.
After the young mother and I finished discussing her concerns, she paused, deep in thought. "You know, I just read so many scary things on the internet," she finally said. "I guess I just needed to hear it from a doctor. Let's give him all of his shots today."
Vaccine hesitators appreciate the time I take to have an open discussion about vaccines. More often than not, they come to the conclusion that they want their child fully protected. Would it have been easier to let this young woman refuse her son's vaccines that day? Yes. But I would be breaking my Hippocratic oath if I stood by while a parent barred an intervention that could prevent her child from contracting a deadly illness. Besides, I wouldn't be able to sleep at night knowing that she might turn to Donald Trump for medical advice.
from Health Affairs Blog http://ift.tt/1mnEXac
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