Aug. 3, 1999

Parents fear growing number of vaccines

By Anita Manning, USA TODAY

Never have American children received so many vaccinations: Most of the 11,000 babies born each day in the USA will get at least 21 vaccinations before they start first grade - more than twice as many as a decade ago.

Never have questions about vaccines been so pointed.

Fueled by the withdrawal of a vaccine last month because of safety concerns and frightening Internet discussions about vaccines, a growing number of parents and politicians are asking whether the sheer number of immunizations now required by states for many children really is necessary - or safe.

On Tuesday, the issue gets an airing in Congress, where Rep. Dan Burton, R-Ind., will chair a hearing on vaccine policy. Surgeon General David Satcher is expected to testify that vaccines are an important part of the nation's public health policy; some parents with wrenching stories will say they believe vaccines hurt their children.

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American Adademy of Pediatrics National Vaccine Information Center

"There have been an increasing number of reports of safety concerns with vaccines," says Burton. "When some parents are more afraid of the vaccine than they are of the vaccine-preventable disease, it is imperative that we fully examine this issue."

For the vast majority of parents, getting the "baby shots" their doctors recommend is automatic. Vaccines protect against diseases that once killed or disabled thousands of children, from polio to rubella to tetanus.

Now, many doctors fear the rumblings over safety will chip away at a national vaccine initiative that has been highly successful, resulting in nationwide vaccination rates of 90% or higher.

"Nothing is risk-free, but for every vaccine that's recommended, the benefits far outweigh the risk of getting the natural disease," says pediatrician Margaret Fisher of St. Christopher's Hospital for Children, a member of the American Academy of Pediatrics' committee on infectious diseases.

Vaccines of the '90s Ten doses of new vaccines have been added in recent years to the list of routine immunizations for children under 2 years old. They include: Hepatitis b vaccine, recommended in 1991, is given in three doses at birth, 1-2 months and 6 months of age to prevent a virus that can cause liver damage or liver cancer later in life. Varicella vaccine, approved in 1995, is given to babies 12-18 months old to prevent chicken pox. Haemophilus influenzae type b, or Hib, was approved in 1990 to prevent bacterial meningitis . It is given at 2, 4 and 6 months of age, or 2, 4 and 12-15 months, depending on which vaccine is used. Rotavirus vaccine, suspended at least until November, was approved in 1998. Given to babies at 2, 4 and 6 months, it prevents infant diarrhea.

Vaccines work by priming the body's immune system to fight against a particular virus or bacterium that is contained in the vaccine itself, either in a weakened or killed form. Then, when the child is exposed to the real, full-strength germ, his immune system recognizes it and can set up strong defenses.

But in chat rooms on the Internet, parents hear about devastating illnesses, even death, that strike otherwise healthy babies shortly after receiving vaccines.

Advocacy groups have raised the possibility of a link between vaccinations and autism, a connection between diabetes and the meningitis-fighting Hib vaccine and an association between the hepatitis B vaccine and multiple sclerosis, chronic fatigue syndrome, rheumatoid arthritis and other autoimmune disorders.

The federal Centers for Disease Control and Prevention says all the claims have been investigated and found unwarranted.

Most vaccines are given to babies before age 2 - the time of life when genetic or other abnormalities are likely to surface. Because the vaccine schedule has babies getting shots every two months or so, any health problem that occurs will happen within a few weeks of getting a vaccine.

But not everyone buys that argument.

"As more and more vaccines are being put on the market, and as more cases of vaccine injuries and deaths are being reported, you are seeing a critical mass" of concern, says Barbara Loe Fisher, cofounder and president of the National Vaccine Information Center (NVIC), a parents' information group. "There's an awareness that there are reactions, that people are becoming sick."

Growing concern

Several recent incidents are adding to worries about vaccines.

On July 15, federal health officials suspended use of the rotavirus vaccine, which prevents a common cause of infant diarrhea, after receiving 15 reports of babies suffering a life-threatening bowel obstruction called intussusception. The CDC and the vaccine's manufacturer, Wyeth Lederle, are taking a closer look to see whether there's a link. Meanwhile, use of the vaccine is postponed at least until November, the start of the rotavirus season.

Just a week earlier, the Food and Drug Administration asked vaccine makers to phase out vaccines that contain the preservative thimerosal, citing concern over low levels of toxic mercury. As a result, the recommendation that all newborns be given the hepatitis b vaccine before they leave the hospital has been changed.

Now, babies born to mothers who test negative for hepatitis b can wait until they're 6 months old to get the vaccine. By this fall, thimerosal-free vaccines should be available.

The CDC and the American Academy of Pediatrics, which together establish vaccine policy, are working to make vaccines safer. In June, they began advising doctors to use injected, instead of oral, polio vaccine, because the oral vaccine contains live virus. About eight cases of polio a year, the only polio occurring in the USA, were caused by the oral vaccine.

Manufacturers are also making efforts to improve safety. The DTP (diphtheria-tetanus-pertussis) vaccine, once dreaded by parents because it caused high fevers, pain and seizures in some babies, has been replaced by a new formulation that has eliminated those side effects.

Federal health officials monitor vaccine safety in at least two ways:

• The Vaccine Adverse Event Reporting System, which received 11,000 complaints last year from doctors, patients or parents; about 15% of those complaints are considered serious.
• The Vaccine Safety Datalink Project, which looks for vaccine reactions among patients in four West Coast HMOs.

"We don't just recommend a vaccine and ignore it," says Barbara Reynolds of the CDC. "We are constantly monitoring data to look for adverse reactions."

But no single trigger will prompt an investigation.

"When you test a vaccine, you do it on thousands of babies, rather than millions," says pediatrician Margaret Fisher, who is not related to Barbara Fisher. "Then, when you give the vaccine to millions of people, clearly you're going to find problems you didn't find originally. With the rotavirus vaccine, the minute there seemed to be a problem, they pulled it immediately. It should make people comfortable that (health officials) are looking out for vaccine safety."

Too late for some

That brings no comfort to Natalie and Deven Corzine of Cincinnati.

Their baby, Sarah Frances, was born two months premature in February. She was tiny, not even 3½ pounds. While in the hospital, her mother says, she got a hepatitis b shot and one for respiratory syncytial virus (RSV), a lung ailment.

Sarah came home from the hospital after three weeks and started gaining weight. By nine weeks of age, she weighed six pounds, and the parents took her to the doctor for her two-month visit.

"It was three days after her original due date," says Natalie Corzine. "My husband and I were worried about the number of vaccines."

But the doctor said it would be OK, and gave Sarah vaccines against six diseases - diphtheria, tetanus and pertussis (given together as DTP), Hib, polio and rotavirus.

Twelve hours later, the baby was dead.

"We think she had a seizure," says Natalie. "Her little fists were clenched, her little eyes were slightly open. My husband went to give her CPR and her tongue was rolled back."

The cause of death was ruled "undetermined," but Natalie says a pathologist told her it was "a vaccine-related death. Her little system was bombarded too much."

Doctors say babies routinely get multiple vaccines at their two-month visit, with the majority doing just fine.

Between 1967 and 1990, the vaccine schedule recommended five shots of DTP, four doses of oral polio vaccine and one injection of measles-mumps-rubella vaccine - a total of 10.

Today, kids get three shots of hepatitis b, five of DTP, three Hib, four polio shots, two measles-mumps-rubella, one varicella (chicken pox) and three oral rotavirus vaccines before they even start school - a total of 21.

Some parents say that's too many. They fear that vaccines, most notably hepatitis b, may be causing an autoimmune response in which the body's immune system sees its own tissue as foreign and attacks it. That can lead to chronic illness.

"We have absolutely suppressed infectious disease in childhood, there's no question," says Barbara Fisher of the parents' information group. "But public health is not only measured by the absence of infectious disease. It's also measured in chronic disease, such as diabetes, asthma, multiple sclerosis, learning disabilities. ... Why are these immune and neurologic disorders on the rise?"

Fisher says parents are questioning "the one-size-fits-all mentality" that requires immunization of children on a prescribed schedule to protect them from diseases they are either not likely to contract, or that won't make them very sick.

For instance, the varicella vaccine that prevents chicken pox, a disease most people endured in childhood with only minor inconvenience. The vaccine is given to one-year-olds, but no one knows yet how long it will last. Critics say it could wear off when children are older - at an age when chicken pox can cause serious illness.

"We need to tailor policies to fit the populations they are aimed at serving," says Barbara Fisher. "Parents ask, 'Why do I have to have my child vaccinated against chicken pox when 99% of children who get it do fine?'"

Overstating the risk?

Michael Belkin of New York, whose five-week-old baby, Lyla Rose, died six hours after her second hepatitis b shot, says the CDC and other health experts are overstating the risk of hepatitis b in kids. The vaccine should not be given routinely to infants, he says.

"When you get down to it, babies are not at risk of getting this disease. It's a disease of sexually promiscuous people and drug users," he says. Under current practice, "you pop out of the womb and first thing you get is a shot for a sexually transmitted disease."

But there is a real risk that young children could contract hepatitis b in non-sexual ways, doctors say, and that's why many states mandate the vaccination for children in school or day care.

"Hepatitis b is transmitted by blood," says pediatrician Fisher, "so what if a child is walking on a beach and steps on a needle? What if they're (wrestling) or cut themselves or if two children decide to be blood brothers? There are all kinds of ways they could be inadvertently exposed to blood. We do want to protect every child we can."

The Corzines are not convinced. They're not opposed to vaccines, they say. They just want them to be safer.

"It's not that I didn't want to vaccinate my daughter," Natalie Corzine says. "I just wanted to wait. What would have been the harm of waiting until she was 10 pounds? Parents should have a right to say what gets pumped into the child They're not listening to us. They're playing God."

But they are listening, doctors say. They point to the suspension of the rotavirus vaccine as one example of the system working. They cite government inquiries, workshops and studies to investigate reports of illness or death possibly related to vaccines. Vaccines, they say, are not foolproof, but they've saved hundreds of millions of lives.

And parents know that, says pediatrician Mark Rosenberg of Barrington, Ill. "Most parents I'm seeing still trust their physicians and the system by which we administer vaccines."

"These individual situations are obviously tragic," he says, but they're the exception, not the rule. "As a scientist, we can't take individual cases and make public policy."

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