Childhood Immunization
A Note on Childhood Immunizations from Dr. Roszell
At this time, Highlands Family Medicine accepts new pediatric patients regardless of their parents intention to follow CDC guidelines for pediatric immunization. Nonetheless, Dr Roszell and Megan Ward, ARNP STRONGLY encourage ALL parents to commit to an immunization schedule which brings them up to date with CDC recommendations and Jefferson County Public Schools requirements by the start of first grade.
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“I unqualifiedly support the Center for Disease Control's schedule of childhood immunizations. I do this as a parent, as a member of a community, as a physician, and as a public health advocate.
Childhood immunizations reduce everyone's risk from a host of bacterial and viral diseases that cause significant death and disability: for centuries, mothers bore 10 children to see 7 die of diseases whose names I know only from the boxes of vaccine in my office refrigerator.
As a doctor in the Highlands, I am lucky to treat the most open, caring, intelligent and questioning people I could hope to find. And as a population, they disproportionately choose not to immunize:
- Some viscerally react to seeing their child stuck with a needle, or find the number and timing of immunizations daunting.
- Some are mistrustful of physicians and pharmaceutical companies, and want to protect their child from a system where they suspect health is secondary to profit.
- Some fear immunizations themselves, and share the beliefs of practitioners, books, groups and news stories that vaccinations cause real or potential health problems.
It is my inclination to respect autonomy; and I see myself as a source of information, rather than a figure of authority. In the past I welcomed non-immunizers, hoping good rapport would lead them to reassess vaccination. If immunization was simply to protect the child I was vaccinating, the only victims were the non-immunizing children themselves.
My agonizing over non-immunization has worsened because I now see that immunizations are in fact for our community. In the winter of 2008, kids were exposed to pertussis at Louisville elementary schools, by non-immunizing classmates. Though those exposed had been immunized as infants, all vaccinations are imperfect: immunity wanes, and some percentage of those who get shots unknowingly fail to develop long-term immunity in the first place. Could the non-immunizers have been my patients? Am I partly responsible?
The unimmunized child in my waiting room is a danger to my other patients, to my staff, to our families, to others who are unable to immunize for health reasons, and to everyone else in the community.
Voluntary public immunization is a rare social contract, something we do to protect others even more than ourselves. Though I can understand that another parent’s instinct might be first with the health of their own child, my belief as a parent was that I had a responsibility to the community. Because I immunized my two children, as have so may others, we have reduced the pool of disease enough that others are able to consider not immunizing.
I would encourage immunization even if I shared the belief that it represented a risk to the individual child. But I am not aware of any harm that ever came to a patient I immunized. And when I look to the sources on which I rely for information, I am unable to find data that links vaccines to autism or any other malady. The American Academy of Family Practice, the American Academy of Pediatrics, the Centers for Disease Control, all unqualifiedly urge me as a physician, and you as a parent, to immunize our children.
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The dozen-odd diseases on the CDC schedule were selected based on many factors:
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The cost and risk of immunizations vs. that of the disease we are fighting.
We no longer universally vaccinate against Small Pox, as the disease exists now only in labs, while the vaccine itself can cause harmful reactions. On the other hand we immunize against Chicken Pox, which, while not terribly dangerous to kids, represents great danger to pregnant women and their unborn.
- The timing of exposure and age of greatest risk from illnesses.
Hepatitis B is transmitted by blood exposure, and is first a threat to the unlucky few who are exposed in their mother’s womb. So we begin shots at birth. Cervical cancer and meningitis represent a risk in teens and early adulthood, and are saved until our second decade so that immunity will be strongest when most needed.
- The number of exposures the immune system requires to develop immunity.
Influenza mutates every year, and requires annually vaccinating a large number of people to slow its passage through the community each winter. Polio requires 4 shots over as many years to produce life-long immunity, and tetanus, diphtheria and pertussis need multiple initial doses and a booster each decade of our lives.
- The number of visits we can reasonably expect of parents for shots.
Certainly the DTaP, Hib, HepB, IPV, Rota and Prevnar a child receives at 2 months could be separated out over individual visits, but at one immunization per week, a child’s two-month shots would only be completed the week before four-month shots began.
This complex arithmetic is done by egg-heads employed by health departments and universities, not by multi-national pharmaceutical companies. These physicians, public health PhDs and laboratory scientists convene each year in Atlanta, and base their decisions on dispassionate population statistics, on microbiology and immunology, and on the best science available.
These scientist’s considerations go far beyond anything I am capable of undertaking, so I put my trust in the Centers for Disease Control. Theirs is the only schedule of immunizations I can recommend to you.
Below is an example of an ideal schedule that we aim for in our office:
Parents who choose to receive the schedule of immunizations recommended by the CDC will be happily provided vaccines at Highlands Family Medicine. I respect that others have proposed alternate immunizations, and Delayed and Alternative Schedules are a gray zone I am willing to discuss with parents as we work together to take good care of your kids.
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Immunization Resources for Parents:
Parents’ Guide to Childhood Immunization: a CDC publication
A more thorough guide than I could ever produce, answering any question you might have about vaccination.
http://www.cdc.gov/vaccines/pubs/parents-guide/downloads/2008-parents-guide.pdf
This American Life: Chicago Public Radio
Episode 370: Ruining It for the Rest of Us, originally aired 12.19.2008; Act One. Shots in the Dark
“Measles cases are higher in the U.S. than they've been in a decade, mostly because more and more nervous parents are refusing to vaccinate their kids. Contributing Editor Susan Burton tells the story of what happened recently in San Diego, when an unvaccinated 7-year-old boy returned home from a trip to Switzerland, bringing with him the measles. By the end of the ordeal, 11 other children caught the disease, and more than 60 kids had to be quarantined. (21 minutes)”
http://www.thisamericanlife.org/Radio_Episode.aspx?sched=1275
The Centers for Disease Control has much more information regarding vaccination at: