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Sunday, September 14, 2014

A Smarter Way to Vaccinate

In the United States we give children more vaccines than any other country in the world. Just three decades ago kids received eight doses of three vaccines and now they receive seventy doses of sixteen different vaccines, and twenty-six are given during the first year of life. 

It’s all part of a plan to prevent deadly disease, but our infant mortality rate is still unacceptably high. The United States ranks fifty-first, behind many developing countries and every developed country except Poland (CIA 2014). Research studies confirm that increasing doses of vaccines are associated with increasing incidence of infant death (Miller and Goldman 2011) and countries with the lowest infant mortality rates are also among those who give their kids the fewest immunizations, notably Sweden, Japan, and Iceland, where kids receive only twelve doses (Miller and Goldman 2011).

As parents are becoming increasingly concerned about adverse effects and doctors are becoming increasingly concerned about kids going unvaccinated, it’s time to reevaluate immunization protocols. We can begin by weighing the risks and benefits of vaccines on a case-by-case basis, implementing alternative vaccine schedules, utilizing harm reduction strategies, treating symptoms of sickness promptly, and keeping kids healthy. Offering options other than the current one-size-fits-all approach can increase immunization rates among families who would otherwise choose to not vaccinate at all and reduce the risk of the most serious side effects when children are immunized.

Vaccine Basics

The purpose of vaccines is to trigger the body to produce antibodies against antigens like bacteria and viruses so if we ever encounter them, we will not become infected with a harmful disease. Different vaccines are made with different triggers. Some contain whole live viruses (chickenpox (varicella), rotavirus, measles, mumps, rubella, flu nasal spray) or viruses that have been inactivated (polio, hepatitis A, injected flu shots). Others are made with proteins, sugars, or toxins produced by bacteria (Haemophilus influenza type B (HIB), diphtheria, tetanus, pertussis, pnuemococcus) or they are artificially engineered (hepatitis B, human papillomavirus (HPV)).

Vaccines are used to promote herd immunity against contagious diseases. In theory, when most of the people in a community are immune to certain viruses or bacteria, diseases will eventually disappear or become rare enough that some people can go safely unvaccinated because the chance of catching them is extremely low. 

However, immunizations have varying degrees of effectiveness and studies show that outbreaks of infections like measles occur among fully vaccinated children (Christie et al. 1994). And because certain microbes like pertussis, influenza, HIB, and HPV evolve new strains to replace ones that are disappearing, vaccines may reduce the risk of illness but these microbes are unlikely to ever be completely eradicated (Weber et al. 2001).

Vaccine Additives

Vaccines can contain several ingredients in addition to the trigger itself. Human tissues (such as lung cells from aborted fetuses) and animal tissues (such as monkey kidney cells, cow blood, and chicken and guinea pig embryos) are often needed to grow the bacteria and viruses used to make vaccines and sometimes they are found in the final product. They have the potential to trigger autoimmune reactions (Agmon-Levin et al. 2009) and allergies including anaphylactic shock, a life-threatening allergic reaction (Sakaguchi et al. 1996).

In some cases aluminum is added as an adjuvant to vaccines to make them more effective. Aluminum is widely recognized as a neurotoxin and it too has been shown to induce autoimmune reactions (Tomljenovic and Shaw 2012). Aluminum also makes shots more painful and when multiple vaccines are given at once, the total amount administered often exceeds safe levels.

Other additives may include mercury, monosodium glutamate (MSG), gelatin, antibiotics, and formaldehyde. Mercury is used in the form of thimersol, a preservative added to certain vaccines (DTaP and some flu shots), and it too is a recognized neurotoxin. MSG can cause allergic reactions in humans and has been shown to cause nerve damage in animals (MagariƱos et al. 1988). Gelatin and antibiotics may also cause allergic reactions, and the overuse of antibiotics is contributing to the rise of antibiotic-resistant superbugs and increasing rates of life-threatening infections. Formaldehyde is a known carcinogen.

It’s difficult to estimate the effects that tiny amounts of these chemicals have on children, but we do know that their bodies are most vulnerable to toxins while they’re still developing, and that the most rapid immune and neurological development extends through the first two years of life. 

We also know that infants do not have fully developed detoxification systems and their immature bodies may be unable to eliminate harmful ingredients found in vaccines during their first six months. And the smaller the body, the bigger the relative dose, yet eleven-pound two-month-old babies are given the same vaccines as forty-five pound five-year-olds who weigh more than four times as much.

Safety Studies

Vaccine safety studies are designed by vaccine manufacturers to follow groups of children for a period of days or weeks after immunization. In the absence of too many severe acute reactions like seizures or anaphylactic shock, the vaccines are considered safe (although some product inserts warn that they have not been evaluated for the potential to cause cancer or impair fertility).

Short-term safety studies tell us nothing about the long-term safety of vaccines, and no long-term studies have ever been done. This would require unbiased, randomized controlled trials in which one group of kids is immunized, another is not, both groups are followed for a period of years, and researchers compare the incidence of illnesses like autoimmune disease, brain injury, and death between the two groups. Because chronic neurologic and immune system disorders can surface years after immunization, it’s impossible to draw definitive conclusions about the long-term effects of vaccines based on the information currently available.

Individualized Approach

The risks and benefits of vaccines should be evaluated on a case-by-case basis. For some individuals, the benefits may outweigh the risks. Children living with certain chronic illnesses have a higher risk of developing infections like chicken pox, hepatitis A, influenza, and pneumococcal disease, and they have a higher risk of developing complications if they catch these illnesses. Their parents and doctors may decide that reducing the risk of developing these infections is more important than avoiding potential side effects of vaccination.

For other individuals, the risks may outweigh the benefits. These individuals include kids who are allergic to vaccine components (like yeast, eggs, or antibiotics) and those who have had a previous adverse or allergic reaction to a vaccine. It includes children with neurological conditions, developmental disorders, and compromised immunity such as:
  • Symptoms of illness or infection within the past week (a cold, cough, fever, sore throat, ear ache, diaper rash, colic, or changes in stool)
  • Antibiotics, steroids, or other immunosuppressive medications taken within the previous three months
  • Autoimmune disease
  • Transplant or transfusion of blood or blood products within the previous three months
  • Immunodeficiencies including HIV, AIDS, no spleen, low platelet levels, leukemia or other cancer, or recent cancer treatment including chemotherapy and radiation
Because people can be infectious before they start showing symptoms, it’s also a good idea to postpone immunizations for anyone with a household member who has been sick during the past week. Caution should be exercised with individuals who have atopic illnesses including allergies, asthma, hay fever, and eczema, or a family history of autoimmune disease. And girls or women who are pregnant, may become pregnant within three months, have given birth within three months, or are currently breastfeeding should also avoid immunization, especially with live virus vaccines.

Alternative Vaccine Schedules

According to the Vaccine Adverse Event Reporting System, most vaccine-related deaths occur during the first year of life and most side effects occur after the simultaneous administration of multiple vaccines (Braun and Ellenberg 1997). 

Parents and doctors who want to reduce these risks by delaying immunization or minimizing the number of vaccines children receive should become familiar with the immunization laws and exemptions in their state (available from the Department of Health). They should also prioritize the ones against the most dangerous diseases for infants including HIB, pneumococcal disease, and pertussis. (Unfortunately, an individual pertussis vaccine isn’t available and currently must be given in the form of DTaP vaccine.)

Some parents choose to delay vaccines for diseases that are usually mild or uncomplicated in babies (rotavirus, chickenpox, hepatitis A); for diseases that are treatable (pneumococcus, tetanus, chickenpox, hepatitis A, HPV); for diseases that are rare in the United States (diphtheria, tetanus, measles, mumps, rubella, polio); or for diseases that are rare in babies (hepatitis A and B, HPV, meningococcal). 

Hepatitis B is an exception and babies born to mothers who test positive for this virus should be immunized at birth because perinatal infections become chronic in 90% of infants and a quarter of them eventually develop liver failure or liver cancer during childhood. 

Live virus vaccines (MMR, flu, varicella) should not be given to infants because they are not effective before the age of one year. Parents of infants may also choose to postpone aluminum-containing vaccines (DTaP, pneumococcal, hepatitis A, some brands of HIB) because aluminum is excreted primarily through the kidneys but filtration isn’t fully efficient until babies are one year old. 

Because a single shot of the MMR vaccine is effective in up to 95% of cases, parents may opt to give just one dose instead of two. Unnecessary MMR, varicella, and hepatitis A vaccines can be avoided by checking for immunity before immunization. Sufficient titers of antibodies in the blood make booster shots unnecessary, whether the antibodies come from being exposed to the virus through a previous vaccine or an actual infection, even if it was mild enough to pass as a cold or go unnoticed. So far we don’t have useful titer tests for bacteria (HIB, pneumococcus, diphtheria, pertussis, meningiococcus) or certain viruses (rotavirus, flu, HPV).

Parents may also choose to delay certain immunizations until children start day care or school and their risk of exposure to certain infections (rotavirus, hepatitis A, HIB, pneumococcus) dramatically increases.

10 Strategies for Harm Reduction

Regardless of when vaccines are given, the following steps can be taken to reduce the risk of adverse reactions:

#1  Investigate the vaccines that are available to you. Most are made by more than one manufacturer and their ingredients often vary, so whenever you can, avoid additives like aluminum, antibiotics, MSG, formaldehyde, human or animal tissues, and thimersol, especially during the critical first two years of life. All childhood vaccines are available in at least one thimersol-free form.

#2  Well in advance of an office visit for vaccination, request and read carefully all of the warnings and contraindications from the manufacturer’s package inserts, which often contain information not included on Vaccine Information Sheets.

#3  Give vaccines in single doses rather than multiple doses whenever they are available. Some vaccines only come in combination, like pertussis and the live triple-virus MMR shot. 

#4  If a vaccine is being drawn from a multidose vial, make sure that the person administering it shakes the vial first to evenly distribute the contents.

#5  Don’t give more than one aluminum-containing vaccine at a time. Don’t give any aluminum-containing shots to premature babies or children with compromised kidney function.

#6  At the time of immunization, check every package insert to verify that the vaccine to be administered is the right one and make sure that it is administered correctly. The manner and location in which shots are given impact the vaccine’s effectiveness as well as symptoms of pain, swelling, and redness that may follow. 

#7  Keep records of each vaccine including the date it was administered, the lot number, and any adverse reactions. Contact your doctor immediately if you observe in your child unusual limpness or pallor, excessive sleepiness, weakness, lack of alertness when awake, a fever above 100.6°F lasting more than 24 hours, persistent high-pitched crying lasting more than three hours, difficulty breathing, convulsions, or seizures. Always report reactions to the Vaccine Adverse Event Reporting System, even if you reported them to your doctor.

#8  Space out vaccines as much as possible to give the immune system time to recover. This is especially important for live-virus vaccines (rotavirus, MMR, varicella, flu) which should be separated by at least 3 to 6 months.

#9  Supplement with probiotics like Lactobacillus and Bifidobacterium for 2 months before immunization and at least 3 months afterward. Studies show that they increase the effectiveness of the MMR vaccine and reduce side effects (Youngster et al. 2011). They may have this effect on other immunizations as well. Probiotics have also been shown to minimize allergic responses and make our bodies more resistant to disease.

#10  Talk to your doctor about supplementing with vitamins A, C, and D. They are necessary for immune function and taking them in supplement form before and after immunization may reduce the risk of adverse effects. Dosages vary by age and weight so inquire about the amounts that are right for your children.

10 Strategies for Infection Prevention

Immunization is only a small part of disease prevention. Parents should take other precautions to prevent infections and keep kids healthy whether they have been vaccinated or not. Bacteria and viruses can only cause complications if they enter the bloodstream so the best medicine is staying healthy and treating infections before they progress. Get started with these ten strategies:

#1  Give babies passive immunity by breastfeeding as long as possible. The World Health Organization recommends exclusive breastfeeding for babies during the first six months of life and continued breastfeeding “up to two years of age or beyond” (WHO 2014).

#2  Minimize exposure to disease-causing microbes by keeping play groups small, avoiding day care and nurseries as long as possible, and preventing children from sharing food, drinks, or personal items such as cups, utensils, and toothbrushes.

#3  Instruct kids to wash their hands thoroughly with soap and hot water before they eat or touch their face but avoid antibacterial products and chemical disinfectants.

#4  Feed kids a healthy diet full of whole vegetables and fruits, healthy fats, and good quality protein.

#5  Help kids cultivate the friendly flora that prevent illness and infection by feeding them cultured and lacto-fermented foods every day. These include yogurt, kefir, cheese, cacao nibs, lacto-fermented pickles, miso soup, tamari, tempeh, vinegar, sauerkraut, and kimchi.

#6  Avoid giving kids processed foods, sweet foods, and sweet drinks including juice.

#7  Keep kids physically active every day for at least one hour and allow them to play outdoors as much as possible.

#8  Make sure that children get at least ten hours of sleep each night.

#9  Keep kids on a regular schedule. This includes the times they wake up, go to bed, and eat meals.

#10  When children do get sick, keep them home from school to prevent any spread of infection and seek treatment for symptoms of cough, fever, or rash that are severe or don't resolve within a few days.

References

Agmon-Levin N, Paz Z, Israeli E, and Shoenfeld Y. “Vaccines and autoimmunity.” Nature Reviews, Rheumatology. 2009 Nov;5(11):648-52.

Braun MM and Ellenberg SS. “Descriptive epidemiology of adverse events after immunization: reports to the Vaccine Adverse Event Reporting System (VAERS), 1991-1994.” Journal of Pediatrics. 1997 Oct;131(4):529-35.

Christie CD, Marx ML, Marchant CD, and Reising SF. “The 1993 epidemic of pertussis in Cincinnati. Resurgence of disease in a highly immunized population of children.” New England Journal of Medicine. 1994 Jul 7;331(1):16-21.

CIA (Central Intelligence Agency). The World Factbook. "Country Comparison: Infant Mortality Rate." https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html. 2014.

MagariƱos AM1, Estivariz F, Morado MI, and De Nicola AF. "Regulation of the central nervous system-pituitary-adrenal axis in rats after neonatal treatment with monosodium glutamate." Neuroendocrinology. 1988 Aug;48(2):105-11.

Miller NZ and Goldman GS. “Infant mortality rates regressed against number of vaccine doses routinely given: is there a biochemical or synergistic toxicity?” Human and Experimental Toxicology. 2011 Sep;30(9):1420-8.

Sakaguchi M, Nakayama T, and Inouye S. “Food allergy to gelatin in children with systemic immediate-type reactions, including anaphylaxis, to vaccines.” Journal of Allergy and Clinical Immunology. 1996 Dec;98(6 Pt 1):1058-61.

Tomljenovic L and Shaw CA. “Mechanisms of aluminum adjuvant toxicity and autoimmunity in pediatric populations.” Lupus. 2012 Feb;21(2):223-30.

Weber C, Boursaux-Eude C, Coralie G, Caro V, and Guiso N. "Polymorphism of Bordetella pertussis isolates circulating for the last 10 years in France, where a single effective whole-cell vaccine has been used for more than 30 years." Journal of Clinical Microbiology. 2001 Dec;39(12):4396-403.

Youngster I, Kozer E, Lazarovitch Z, Broide E, and Goldman M. “Probiotics and the immunological response to infant vaccinations: a prospective, placebo controlled pilot study.” Archives of Disease in Childhood. 2011 Apr;96(4):345-9.

WHO (World Health Organization). "Breastfeeding." http://www.who.int/topics/breastfeeding/en/. 2014.

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