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Vaccination is one of the hot topics in attachment parenting circles. Those who challenge accepted beliefs about parenting are often willing to challenge accepted medical wisdom as well. It's not unusual to run across AP parents who are selective vaccinators (who believe that children should have fewer vaccines, or that the vaccines should be administered later, than recommended by groups such as the AAP), or anti-vaccinators, who believe that children should not be vaccinated at all.
On this page, I'm going to try to present and organize some of the available information about vaccination. I believe that it's important for each parent to consider carefully the evidence and then decide what to do for their own child. I'll link to pro-, selective-, and anti-vaccination sites so you can make up your own mind.
To be up front with my own bias: I believe that the benefits of vaccination outweigh the risks, and that vaccination has been one of the most important public health advances in history. We have not researched all of the individual vaccines yet, but so far, we're planning to have our children vaccinated on the standard schedule.
I do want to clarify that when I say the benefits of vaccination outweigh the risks, I am not writing about any individual child. For each and every child who is harmed by vaccination (and I am sure that there are some; I am not one of those who believes that vaccination is magic) the risks are incalculable. Having a child hurt by anything is tragic; having a child hurt as a direct consequence of a parent's decision is overwhelmingly so.
Where the benefits outweigh the risks is on the level of society as a whole. If you believe the evidence that vaccines are directly responsible for suppressing epidemics of deadly childhood diseases, then you have to find some way to strike a balance between the tragedy of the epidemics and the tragedy of the adverse vaccine reactions. It is an extremely difficult choice to make, and I don't think any parent can be condemned for making the choice in whatever manner works for them.
When I present vaccination information I'm trying to do the best I can to make sense of the evidence and pass on the results of my research fully and fairly. I welcome any additional information readers would care to pass on for this page.
The "official" recommended vaccination schedule in the USA is a joint production of the AAP, the CDC, and the AAFP. The most recent version was published in late 2001 for the year 2002,
Of course, other countries have their own official schedules. You can refer to the version from the CPS or the RACGP for two of these. Though there are differences between the individual schedules, broadly speaking they recommend roughly the same vaccines at roughly the same ages.
Contrary to popular belief, vaccinations are generally not mandatory. That is, while there may be state laws requiring vaccination for certain diseases, there are always loopholes.
For an example, consider the MMR vaccination. The CDC says 43 states now require mumps immunization (not the whole shotgun) for entry into school.
However, note that many of these mandatory vaccination laws have provisions for parents to opt out. The law in Washington state (where I am), for example, reads:
"Any child shall be exempt in whole or in part from the immunization measures required by RCW 28A.210.060 through 28A.210.170 upon the presentation of any one or more of the following, on a form prescribed by the department of health: (1) A written certification signed by any physician licensed to practice medicine pursuant to chapter 18.71 or 18.57 RCW that a particular vaccine required by rule of the state board of health is, in his or her judgment, not advisable for the child: PROVIDED, That when it is determined that this particular vaccine is no longer contraindicated, the child will be required to have the vaccine; (2) A written certification signed by any parent or legal guardian of the child or any adult in loco parentis to the child that the religious beliefs of the signator are contrary to the required immunization measures; and (3) A written certification signed by any parent or legal guardian of the child or any adult in loco parentis to the child that the signator has either a philosophical or personal objection to the immunization of the child. [1991 c 3 ? 290; 1990 c 33 ? 193; 1984 c 40 ? 5; 1979 ex.s. c 118 ? 4. Formerly RCW 28A.31.106.]"
One common claim of anti-vaccination sites is that DPT vaccination causes SIDS in at least some children. Often this is coupled with the claim that SIDS deaths dropped in Japan when vaccinations were postponed. I've composed a separate page collecting evidence pro and con on this claim. My own evaluation is that this claim is not supported by the evidence.
Those who advocate delaying vaccination often cite the fact that the immune system does not mature until two years of age. I've posted a separate page to address this topic.
Many vaccines have used Thimerosal, an organic mercury compound, as a preservative. This became a concern when total mercury levels for a full immunization series started to reach a level that the EPA considers potentially dangerous. As a result, the AAP has recommended moving away from Thimerosal in vaccines, while cautioning that
"The larger risks of not vaccinating children far outweigh any known risk of exposure to thimerosal-containing vaccines."
In 1999, when this risk started being discussed, some brands of DTaP, Hib, Hepatitis B, and PCV vaccines contained Thimerosal. No Thimerosal was ever used in Polio, MMR, or varicella vaccines. By now (2001), it is possible to avoid Thimerosal-containing vaccines completely, although there are still vaccines being used that contain Thimerosal.
The May 2001 issue of Pediatrics magazine published a review article, "An Assessment of Thimerosal Use in Childhood Vaccines," containing details of the exposure levels and potential risks. The article is only available to subscribers, but you can read the abstract online.
On October 2, 2001, the Institute of Medicine released their Immunization Safety Review: Thimerosal-Containing Vaccines and Neurodevelopmental Disorders report. The entire report is available online, though as it's 90 pages long it may take a while. They specifically looked at proposed connections between Thimerosal and Autism, ADHD, and delayed language. A few quotes from the executive summary:
"The committee concludes that although the hypothesis that exposure to thimerosal-containing vaccines could be associated with neurodevelopmental disorders is not established and rests on indirect and incomplete information, primarily from analogies with methylmercury and levels of maximum mercury exposure from vaccines given in children, the hypothesis is biologically plausible."
"[T]he committee concludes that the evidence is inadequate to accept or reject a causal relationship between exposure to thimerosal from vaccines and the neurodevelopmental disorders of autism, ADHD, and speech or language delay."
Despite the weak evidence, the IOM report strongly supports the decision to remove Thimerosal from vaccines. They also call for further research to clarify the risks.
My personal recommendation is that you always request in advance a copy of the vaccine insert for the particular brand your pediatrician uses, and if it proves to contain Thimerosal, discuss this with your pediatrician before immunization. It is possible to order another brand, though (because of minimum order sizes) this may be expensive.
Update 12/5/2003: By now there shouldn't be any Thimerosal-containing vaccines still circulating. Nevertheless, it's still worth reading the inserts to understand vaccine risks. Also, in November 2003 there was an article in Pediatrics (abstract, full text for subscribers) titled "Safety of Thimerosal-Containing Vaccines: A Two-Phased Study of Computerized Health Maintenance Organization Databases". The authors looked at the records of about 140,000 children, looking for associations between mercury exposure and neurological disorders. They did find an association between mercury and tics at one HMO, and between mercury and delayed language development at another, but were not able to confirm either association with records from a third HMO. Between that and imperfect record keeping, the authors do not come to any strong conclusions one way or the other as to the safety of Thimerosal.
section added 12/5/2003
In December 2003, Pediatrics ran an article (abstract, full text for subscribers) titled "Addressing Parents' Concerns: Do Vaccines Contain Harmful Preservatives, Adjuvants, Additives, or Residuals?" The authors survey the literature and offer an overview of findings on a number of different ingredients found in vaccines:
I've reviewed The Vaccine Guide, by Randall Neustaedter and Vaccinating Your Child, by Sharon G. Humiston & Cynthia Good, on another page.
As our child needs individual vaccines, I plan to dig into them each in more detail. Here's what I've looked at so far.
| AAFP | American Association of Family Physicians |
| AAP | American Association of Pediatricians |
| AMA | American Medical Association |
| AP | Attachment Parenting |
| CDC | Centers for Disease Control and Prevention (US government agency) |
| CPS | Canadian Paediatric Society |
| DPT | Diptheria, pertussis, tetanus vaccination |
| MMR | Measles, mumps, rubella vaccination |
| NVPO | National Vaccine Program Office (part of the CDC) |
| RACGP | Royal Australian College of General Practitioners |
| VAERS | Vaccine Adverse Event Reporting System |