As some have seen in the news, there is an alarming trend in Pediatric offices toward strong-arming parents into vaccinating their children and giving them their marching orders to find a new Pediatrician. Those who know me will tell you that I’m a strong proponent of vaccinations. I believe that vaccines are safe and effective. As a world medical traveler, I’ve had all mine and then some, including the smallpox vaccine as a child.
However, I refuse to try and dictate to parents what they will or won’t do with vaccines. A pinch of caring and compasion I think will go further than a pound of forceful ‘persuasion.’ I will try to persuade parents through a good patient-physician relationship where they can trust that the vaccine information I present to them is sound and reasonable. I must and will, however, put this decision in their hands as the parents of children that they love deeply.
There are three groups of children that I think we need to consider here. The children in the first group are those who are ill and cannot receive vaccinations as a result. Their parents want them to be able to attend school and try to live as normal a life as possible free from the risk of infection with viruses like measles and such wherever they go. The children in the second group are those whose parents are wary, even fearful, of the vaccines harming their children, and elect to refuse some or all of the vaccines, or opt for a different vaccine schedule than the current recommendations. The children in the third group are those whose parents are already planning to vaccinate per published recommendations.
Children in the first group who can’t receive vaccinations are at risk everywhere in society unfortunately. Much as I would like, I cannot protect them wherever they are. I sometimes wonder if the same parents who demand that all other children be vaccinated to protect their children, are also careful about taking them out to large venues. For example, I suspect that some 50,000 people a day may pass through WalMart’s 24-hour facilities. I am suspicious that everything that a child could touches in these places puts them at risk of infection. I have no studies to back this up, but that is my suspicion, nonetheless. I care for children with significant immune deficiencies myself, and their parents and I always have the discussion about these risk factors, and I am very aware of the needs of these children.
Children in the second group who may receive only few or no vaccines are at risk of getting the infections when they are exposed to others who bring in the infections across our borders. Unlike Yellow Fever, where visitors to endemic countries must be vaccinated prior to travel, and who must also present a Yellow Fever certificate before regaining entry back into the United States, we have no such screening for any other contagious infections. Even Ebola screenings where death rates are upwards of 70% or more, is not properly done before a person reenters from an endemic Ebola area by simply measuring a temple temperature.
Children in the third group are those who are being vaccinated according to schedule. With respect to the MMR vaccination and measles, these children however are at risk for a period of up to the first year where they have limited or no immunity. The MMR is not routinely given until on or after the first birthday. This is because the seroconversion rate, which is the measure of vaccine effectiveness, after the one year measles vaccination is around 95%.
While the solution for the first group lies in exposure prevention on a day to day basis, and for the second group in convincing parents to vaccinate, there is something more I can do to help the third group, and perhaps very significantly. It may also help to limit the exposure of immuncompromised children more effectively than trying mandate that all children receive the present schedule of vaccines.
Children can get the MMR vaccine before their first birthday. However they will still be required to get vaccinated according to the regular two-dose schedule at and beyond age one year. It has been demonstrated that 74% of children who get MMR at 6 months do seroconvert and become immune to measles. Over 89% of those vaccinated at 8 months have been shown to acquire measles immunity.
It is already recommended that unvaccinated children as young as 6 months get the MMR prior to travel to endemic areas of the world or during local outbreaks of measles. I am now officially recommending that parents of my patients consider giving their children their first MMR at age 6 months. Currently here in Georgia they will still have to have two more MMRs at or beyond their first birthday for entities that require the official form 3231 for attendance. This will, I think, significantly reduce the susceptible population of young children, and indirectly reduce some of the risks to the first group of children, whose parents are particular concerned about exposure.
What about immnity to measles in the first 6 months of life then? Because the largest antibody transfer from mother to child occurs at some point prior to delivery, I’m recommending that all women who have low measles, mumps, or rubella titers, be vaccinated prior to pregnancy. Pregnant women or those planning to soon get pregnant within 28 days should first discuss MMR vaccination with their obstetrician.
The CDC recommendations against live viruse MMR vaccination during pregnancy are also based, according to the AAP Redbook, on theoretical risks of infection to the unborn baby. Women have been unknowingly vaccinated during pregnancy without negative effects. Many physicians caring for expectant mothers are starting to check for the presence of measles antibodies. Women thinking about becoming pregnant or who are pregnant need to discuss MMR vaccination with their obstetrician.
Prenatal transfer a measure of their measles antibdoy to the children of mothers who are measles seropositive, which can last up until perhaps 4 months of age. Breast feeding does transfer some antibodies but I don’t think that the quantitative effect is really known there, and it cannot be relied on in lieu of prenatal seropositivity.
This policy should help significantly to narrow the susceptibility of healthy children who are being vaccinated. The problem with forcing the current vaccination schedule on all children seems politically driven rather than well-reasoned, though I understand the fear behind it. It will certainly not stop the entry of measles into our country across the border which is how the virus is getting here. Until we demand verifcation of an approved MMR vaccination by all citizens and non-citizens coming through customs, and until we fully control illegal entry at our borders, we will continue to be at risk for measles. Mandatory vaccination will gain nothing but the control of one group of people over another, and it will further limit the shrinking freedoms we as Americans have traditional enjoyed and fought and died for.
Those who are interested in MMR vaccination before the first birthday should call our office and discuss all the particulars of insurance coverage, risks, etc. More information about the current MMR recommendations are found at these web sites below to support the data that I have presented.
Ron Smith, MD, Pediatrics