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shots shots shots!
By | July 13, 2009
questions i get frequently:
do shots have mercury in them? do mercury shots cause autism? do shots have aluminum in them? does aluminum cause kidney damage? does the chickenpox shot give you chickenpox? does the flu shot give you the flu? will the HPV shot kill me? why does a 2-month old get the same dose as a 1-year-old? is it safe to give a baby six shots at a time? can’t we wait to start shots when my baby is one year old? aren’t “childhood diseases” actually pretty mild? isn’t it better for the immune system to fight off the “natural” germ, than to fight off the shot?
when i had my first baby – 28 years ago – one of my concerns was whether it would be safe for her to get shots.
i didn’t ask my doctor, because i figured i knew what the doctor would say. i went to the library. this was before the internets were invented, so i mainly read scientific and historical papers. i also regularly read “mothering” magazine, which was very anti-immunization at the time, and occasionally “parenting,” which was very pro-vax.
my eventual conclusion was that i’d give it a try.
i had three kids, and they all got shots. (i get shots myself, staying up to date so as not to spread infections to people who aren’t vaccinated.) in the meantime, i went to medical school (etc.), and this added a bunch of other experiences to my parental perspective.
i get a lot of questions about shots. so i thought i’d write a post about shots, baby shots in particular.
this is harder than you’d expect! in the first two tries, i kept ending up writing about childhood diseases and how awful they are. and i feel like that’s beside the point. parents who are concerned about vaccination already know that childhood diseases are awful.
like most doctors, i have cared for really, really, really sick babies and children before – more often than any individual parent (a lot more than i did as a parent of small kids). so i have this doctor-y knee-jerk reaction to “childhood diseases.” i know in my heart that the disease is worse than the shot. and i won’t re-run the statistics for you, about measles encephalitis, and rubella deafblindness, etc.
for most of us, our concerns do not arise because we have some phobia about mercury or aluminum or whatever we may have heard is an ingredient in this or that vaccine. after all, many of us live with mercury fillings in our teeth and mercury-red ink in our tattoos; we cook with aluminum, and don’t mind the aluminum in our beverage cans. (we eat canned tuna fish, hitting both bases at once.) we recognize that these are trace amounts of metals, just as they are in shots, and not likely to harm us, because our bodies – even our wee infant bodies – are pretty darned resilient.
i think that for a lot of us, our concerns arise after being confronted with a vast amount of information that is not only conflicting, but violently conflicting. the pro- and anti-vaccination sides both boldly announce that the other side is directly responsible for the death and permanent disability of large numbers of children. one side reveals, at great length, that government health agencies and individual physicians lie and deceive and distort the truth, and get away scott-free. the other side reveals that anti-vaccination folks falsify their data, have crackpot beliefs that are demonstrably false, exaggerate and threaten and play on parents’ worst insecurities. this leaves us with an uneasy feeling that something is terribly wrong here, and we are going to have to kind of guess what it is. we can’t just calmly ignore it, because both sides have assured us that milions of lives are at stake, starting with our own two-month-old infant’s.
so either we take the plunge, as i did with my kids – get the shots on the usual schedule and cross our fingers – and note with puzzlement that nothing happens – the child might get a sore leg or run a low-grade fever for a day, same as we did when we got our flu shot last year. this is actually all i’ve ever seen happen after a set of vaccinations. like everyone else, i have heard of plenty of other reactions, but that’s all i’ve ever personally seen, after hundreds of sets of shots.
years pass, the kids get through the shots, and for one family at least, the debate is over.
or else we try to strike some sort of compromise: we’ll try the shots, but we want to start later, or we only want certain shots, or we only want them one at a time, and we hope that this will protect our babies from harm. then we might try to find a doctor who will go along with our plans. and that may be an unpleasant experience, especially if we have a doctor who is in a hurry. it can easily turn into an encounter that leaves the parents nervously wondering if the doctor is a government health official who is ignorant of or concealing the awful truth, and the doctor nervously wondering if the parent is a lawsuit-happy crackpot. trust and mutual respect can go right out the window.
some doctors will bend or rearrange the shots-schedule if the parents speak strongly against it; they worry that otherwise, the parents might reject medical care altogether, and then something dreadful might happen, and one way or another, the doctor will be medically and legally responsible for the outcome. other doctors become uneasy when parents appear to reject their medical training and advice, which are both parties’ whole reason for meeting together in the first place, and they don’t want to set a precedent, so they say, if you want to be your child’s doctor instead of me, then go be your child’s doctor and leave me out of it; don’t ask me to toss out my entire medical education.
most doctors just give a little speech about childhood diseases and how awful they are. (if you need to hear my little speech, just ask.) and most parents say, but what about side effects from the shot? and the doctors say, i’ve never seen that before, but if there are side effects, we will treat them. and the parents and doctors all say, well, okay then.
as i have said in previous posts, i actually think that vaccination-immunization is the wave of the future, as far as medicine goes. we don’t have good ways to treat most viral diseases (example: HIV), and the drugs we relied on for 50 years for bacterial and other infections are working less and less well (example: tuberculosis). meanwhile, our immune systems work behind the scenes 24/7, fighting off bugs, fungi, parasites, and tumors. thanks to biochemistry and microbiology, we can figure out how they do it. immunizations that alert our systems before we get infected/ get infested/ get cancer – medicine that works with our bodies’ “intuitive” or “ecological” powers, instead of just trying to throw a lot of poisons at infections and tumors – that’s the wave of the future.
so i guess i’m a vaccination believer – a booster, if you will (ha, ha) – and a big believer in our bodies’ resilience and inborn/evolutionary smartness, which are the secret of why vaccinations work.
but i remain sympathetic to parents’ concerns, because i’ve been there. and i’ll continue to help people figure out their best decisions, and to share what i know and am able to find out.
interesting shots facts
shots with no mercury (brand names):
anthrax: biothrax
dtap (diphtheria, pertussis, tetanus): infanrix, dapacel
dtap+hep b+polio: pediarix
td (tetanus, diphtheria): generic
tdap: adacel, boostrix
hib (hemophilus influenzae: pneumonia, meningitis): actihib/omnihib; hibtiter; pedvax hib liquid
hib+hepatits b: comvax
hepatitis a: havrix; vaqta
hepatits b: engerix-b; recombivax ped/ad/dialysis
flu: fluzone free; flumist (live)
mmr (measles, mumps, rubella): mmr-ii
meningitis: menactra a, c, y, and w-135
pneumococcus (pneumonia, meningitis): prevnar; pneumovax 23
polio: ipol; poliovax
rabies: imovax, rabavert
smallpox: acamwoo (no longer given)
typhoid fever: typhim vi; vivotif
varicella (chickenpox): varivax
yellow fever: y-f-vax
mercury in plasma-derived products:
rh-disease prevention: rhogam, none since 2001; ayrho, none since 1996; winrho, none ever
pit viper/ coral snake antivenin: 15-vial dose = 4.7 mg mercury
pit viper antivenin: 1.88 mg in 18-vial dose
black widow spider antivenin: 2 vials = 0.25 mg (max dose, by law)
note: pit vipers include rattlesnakes, cottonmouths, moccasins, copperheads.
fda shots-research labs, current projects, 4 examples (out of many):
Characterization of Vaccines Targeting Surface Carbohydrates, Wille Vann, PhD
“Bacteria and humans cells are coated with sugar chains often referred to as carbohydrates. Carbohydrate structures play essential roles in infection of humans by bacteria and in the protection of us against disease by vaccination. These carbohydrate coatings make excellent targets for prevention and control of disease. For example, tetanus and botulinum toxins enter human nerve cells through their interactions with carbohydrates on the surface of human cells. Furthermore, the carbohydrate coatings of bacteria that cause meningitis are used to manufacture vaccines against these bacteria.”
Biomarkers of Vaccine Safety and Efficacy for Diphtheria Vaccines, Michael Schmitt, PhD
“Vaccines have been effective in the control of bacterial diseases such as diphtheria, a severe respiratory disease… However, the recent diphtheria epidemic in Russia as well as studies showing reduced immunity against diphtheria among adults in the United States and countries throughout the world has been disconcerting. These and other recent findings support a need for a new generation of vaccines that will confer longer lasting immunity, limit transmission by eradicating the organism from vaccinated people, and reduce adverse events associated with diphtheria vaccination… Specific studies have analyzed surface proteins that are involved in the binding and acquisition of iron, an element that is thought to be essential for this bacterium to productively infect humans. Protein receptors on the surface of C. diphtheriae are candidates for a new generation of diphtheria vaccines.”
Studies of Efficacy, Safety and Potency Assay Development for… Vaccines against Hepatitis Viruses, Marian Major, PhD
“HCV [hepatitis C] is a serious public health concern, there is no vaccine and 85% of people that become infected with the virus develop persistent infections that can, in later life, lead to severe liver problems such as cirrhosis or hepatocellular carcinoma… Vaccine development for HCV has proven difficult. Increasingly new and innovative approaches are being employed such as nanotechnology and T lymphocyte cell (T-cell) based, rather than antibody based, prophylactic and therapeutic vaccines… We need to be able to evaluate the safety of these products and understand or provide guidance on development of assays for potency.”
Establishment of Markers of Viral Vaccine Safety and Efficacy, Steven Rubin, MD
“Use of live, attenuated vaccines is one of the most effective means of protecting individuals from disease and death following virus infection. Live, attenuated vaccines are weakened versions of viruses… Attenuation is typically achieved by repeated passage of the wild type virus under unnatural conditions (different substrates, temperatures, etc). There is no established number of passages required for attenuation… Development of tests capable of correctly assessing a candidate vaccine’s attenuation profile is therefore essential to the licensure of safe and effective vaccines… This research program supports vaccine safety and efficacy concerns through: (1) Development of in vivo, in vitro and molecular tests for assessing the safety of vaccines for the nervous system, including mumps vaccine, live influenza vaccine and vaccinia-based smallpox vaccines… and (2) Identification of surrogate immunological markers of protective efficacy.”
childhood shots details:
dtap: diphtheria toxoid + tetanus toxoid + pertussis – all bacteria.
diphtheria and pertussis (whooping cough) are respiratory diseases. tetanus is a nervous system disease.
the diseases of diphtheria and tetanus are caused by toxins released by the bacteria, so the shot is against the toxin.
need 5 doses, then tdap booster every 10 years.
protects 80%–85% from pertussis, 95% from diphtheria, nearly 100% from tetanus.
hepatitis b shot: surface molecule from a killed virus.
need 3 doses, first one at birth if mom has chronic hepatitis b.
protects 98-100%.
hib: hemophilus influenzae b, which is a meningitis-causing bacterium (not an influenza virus).
vaccine is a killed bacterium.
3 or 4 doses, depending on brand.
protect 95-100%.
doesn’t work in babies younger than 6 wks.
pneumococcus: a pneumonia/meningitis-causing bacterium.
killed, covers 7 strains of the bacterium.
4 doses.
>90% protected.
polio: a nervous system virus.
killed, 3 strains of virus.
4 doses are recommended (includes school-age booster).
protects 99% who get 3 or more doses.
mmr: measles virus + mumps virus + rubella virus.
weakened live virus – not contagious.
2 doses.
protects 99% against measles, 95% against mumps and rubella.
rotavirus: a severe-diarrhea-causing virus.
live, oral solution (not a shot); 5 strains.
3 doses at 2, 4, 6 months of age – no later (natural virus not as bad when older).
protects 98% from severe diarrhea.
varicella: chickenpox-causing virus.
live, 2 doses, protects 70-90%.
1% later get mild case chickenpox, even though had the shot.
risk from disease vs. from shots, courtesy of the oregon dept of human services
from mmr diseases:
measles encephalitis: 1 in 2,000
mumps encephalitis: 1 in 300
rubella, congenital: 1 in 4
from mmr shot:
encephalitis or severe allergic reaction: 1 in 1,000,000
from dtap diseases:
diphtheria, death: 1 in 20
tetanus death: 3 in 100
pertussis: pneumonia, 1 in 8; encephalitis, 1 in 20; death, 1 in 200
from dtap shot:
continuous crying, then full recovery: 1 in 100
convulsions or shock, then full recovery: 1 in 1,750
acute encephalopathy: 0-10.5 in 1,000,000
death: none
vaccine-preventable-disease news:
the most recently reported case of smallpox was in 1977, in somalia.
the most recently reported case of polio was on june 21st of this year, in india. so far in 2009, 642 cases have been reported worldwide.
the most recently reported case of diphtheria in the u.s. was in 2003: a 63-year-old man in pennsylvania, who had not been vaccinated, visited haiti, where he caught the disease. he was sick for 17 days, then died.
countries with endemic diphtheria:
Algeria, Angola, Egypt, Niger, Nigeria, Sudan, ’sub-Saharan countries’, Bolivia, Brazil, Colombia, Dominican Republic, Ecuador, Haiti, Paraguay, Afghanistan, Bangladesh, Bhutan, Myanmar, Cambodia, China, India, Indonesia, Laos, Malaysia, Mongolia, Nepal, Pakistan, Papua New Guinea, Philippines, Thailand, Vietnam, Iran, Iraq, Saudi Arabia, Syria, Turkey, Yemen, Albania, Russia, and countries of the former Soviet Union.
my favorite immunology “waves of the future” website, for news and commentary about development of shots against HIV, malaria, cancer, and more (warning: author hostile to anti-vax folks):
mystery rays from outer space.
Topics: Uncategorized | 2 Comments »
July 13th, 2009 at 9:39 pm
Wow. What a great and thorough post! Some of this will become my own “script,” if you will.
As an RN I always respect patients’ and parents’ right-of-refusal but it must be INFORMED refusal. It’s a difficult issue. I’ve worked with–been co-workers with– people who have struggled with the lifelong effects of polio (crippling, literally) and also know as friends “natural” people who have not given their four-year-old one single shot. And I think, not even polio? My dad tells the story of the sugar-cube truck coming around in the 1950’s with a miracle- polio prevention. And I think that these kind of parents are raising the kid who will grow into a socially-conscious adult who may want to travel to, say, India someday, or join the Peace Corps. What then?
I insisted that my mom get Zostavax after seeing a dear, dear elderly man- a family friend- suffer for months from shingles. Suffer. After years of suffering from arthritis and finally getting a belated hip replacement. It is very sad. It was Christmastime when he first started tingling and he is still in pain. There is a vaccination against shingles now, and he hadn’t had it.
I’ve heard the autism argument and blogged about it too. The whole concept that there was any link whatsoever came from one tiny flawed study (click on “autism” on my blog’s tag cloud, and the expose is linked there). I count Aspies and Auties among my friends as well, so I do care about this aspect too.
Thanks for this post.
July 19th, 2009 at 1:46 pm
Dr. Leigh, this was a rare pleasure to read, reflecting my attitude in general toward alternative orientations toward health and diet: respectful, open, but in the end leaning toward evidence based.