Vaccine Delay

A news item we posted to our Facebook page about parents who delay their children’s vaccinations generated some detailed comments and questions. Inspired by and wanting to respond to them, Dr. Wolynn wrote this Note… 

Some parents delay or stagger vaccines, because they presume that doing so is safer. But this is a false assumption based on…

…nothing. Not evidence, not fact, not science, not research. It’s on years (and years) of all of those things that immunization medicine, and the immunization schedule, is based.

vaccinationsThe reason infants receive multiple vaccines in the first 18 months of life is based on this fact: that infants and young children who become infected with these vaccine-preventable diseases are at greatest risk to become seriously ill, suffer prolonged or life-long complications, and possibly die. (Talk about bad side effects.)

We attempt to protect infants, families, communities, and all of society with our current CDC recommended vaccine schedule. Infants require the boosted protection elicited by the multiple dose regimen to optimize their ability to fight off these horrible diseases.  We’re incredibly fortunate that we no longer regularly witness the disease and death brought on by these infections, but they still exist. And, in populations without vaccines, they continue to maim and kill.

Dr. Pai could give gruesome details of the infants and children who suffered and died before many of these vaccines were available. And the rest of us can still tell you about the deaths and suffering seen more recently in infants and children who were too young to get the vaccines, or who were unable to get the vaccines, or — yes, it happens, and it’s terrible — whose parents delayed or refused the vaccines.

I want to make a clear point here about herd immunity. This is the concept that the majority of a group must be protected to reduce or eliminate vaccine-preventable diseases. Depending on the disease, the % of the “herd” that must be immunized to stop the spread varies, but the closer we get to 100% the better. The “herd” will never be 100% protected, because most vaccines are not approved (based on the licensing studies ) to be administered under the age of 6 weeks, because infants require a series of two or three or more doses to achieve maximum protection, and because children and adults who are immunosuppressed by medication or disease can not receive some vaccines. So we hope to vaccinate all eligible children and adults on time with all appropriate vaccines.

Why? To protect the vaccine recipients and the infants, children, and others who, if infected, face the greatest risk of disease and death.

To answer some specific concerns raised in the comments:

What are the delay and refusal rates in Pittsburgh?

The refusal rate in our area (Greater Pittsburgh) is likely less than 3%. Delaying % ? Not sure.

Kids Plus, as many of you know, has a strong stance regarding the importance of vaccines. We expect that, unless medically contraindicated, all of our patients will receive all their vaccines on time. For families who choose to skip or significantly delay vaccines, we ask them to find a practice more supportive of their philosophy. We do this because we believe that immunizations are the cornerstone of preventive/Well care.

We also do this because we are doing everything possible to prevent your newborn, infant, or immunosuppressed child from being infected by a another child in our practice. Pertussis, measles, pneumococal and other diseases frequently can present with ‘cold’ or other viral-like symptoms. In spite of our modern medical society, kids are maimed and die in ERs and hospitals even if a correct diagnosis is made and correct therapy is started promptly.

Prevention is THE strategy to keep infants and children safe. Treating these diseases once they’ve been acquired, even with all our advances in modern medicine, is a crap shoot.

Does Kids Plus support vaccine delay?

As you know, we do not advocate for even slight breaking up or spacing out of vaccines.  There is no benefit, and only the risk of unnecessary delayed protection when vaccines are delayed. When parents in the past asked me “Which vaccines should the baby get today?” (and which ones should they get later as they try to decide their delay strategy) I often wanted to respond: “Which ones don’t you want your child to be infected with, or be put at risk for death because of, today?”

I know that sounds harsh, but again, as doctors, we must present the facts. The realities. The results of years and years (and years) of evidence-based medicine and research. There is NO data, no reputable, peer-reviewed study to suggest ANY benefit to delaying. But there are plenty of studies to suggest the increased risk from delayed and incomplete immunity to these vaccine-preventable diseases.

There is a “one-size” fits all strategy. It’s based on years of scientific evidence and medical research, and it’s exactly what we need to optimize our individual, societal, and public health.

Other than excluding those individuals for whom a vaccine is clearly (medically) contraindicated, everyone else should be immunized as indicated by the CDC schedule. There are plenty of examples of how poorly targeted/focused vaccine regimens do not protect against disease. The pre-Universal Flu recommendations are an excellent example of this failure. “Customized” vaccine schedules are like driving your infant around in the front passenger seat of your car without using a carseat or safety belt. Odds are good you’ll get to your destination and the baby will be fine. But the science clearly shows that you’re risking your baby’s life, and that you actually have nothing to gain in the process.

I can’t stress this often, or strongly, enough: there is NO valid, scientific article or study that shows benefit to delaying vaccine. At Kids Plus, we support evidence-based care. That’s why we strongly recommend vaccines schedules as outlined by the CDC and AAP.

All parents would like the very best care for their children. And there is no debate — none — in the medical and scientific communities that the best possible care for children is to follow the vaccine schedules as outlined by the CDC and AAP.

Dr. Todd Wolynn, the CEO of Kids Plus Pediatrics, lectures nationally on the subject of immunizations.