Vaccine safety: Take two

After a few days of obsessive research following last week’s initial post about whether to get a flu shot for Will, I wrote this column on the subject of vaccine safety in today’s Ledger-Enquirer. I sought out the advice of my pediatrician, my midwife, an RN/lactation consultant, and a Washington-Based journalist who’s been writing about vaccine safety for several years. Some of their reaction is in the column – but you’ll find more that didn’t make it into the print edition at the bottom of this post.
Print-edition correction: For those of you coming here after reading the print-edition of the column, there was an editing mix-up that led to a major error in that column. Some of Dr. Mansfield's comments were attributed to Stephanie Cave, who I never talked to at all. The online edition of the column is correct -- click on the link above and jump to page two to read what Dr. Mansfield said in full.

The honest truth is, I’m a mess when it comes to this one little decision: One day I lean toward the flu shot, the next day I lean against it. It’s sort of a battle between something in my gut (that says we put plenty of unnatural substances into our bodies already without adding an optional flu shot every year) and something more cerebral (that says the science says it’s safe and your doctor’s recommending it, so get over it and give your kid the shot). For now Rob and I are still stalling on the issue.

If you’re hoping to make an informed decision you might want to do some reading of your own. Here are some of the web sites and articles I visited over the course of preparing this column. (If you wade into the first couple web sites be sure to also visit some of the articles on the second and third list to balance things out.):

On the vaccines can be risky side of the debate:

National Vaccine Information Center (a national, non-profit organization dedicated to preventing vaccine injuries and deaths through public education and defending the right to informed consent to vaccination)

Vaccination Risk Awareness Network (a Canadian-based, not-for-profit educational society, founded by parents whose children have suffered vaccine reactions and injuries)

The Autism Research Institute, a non-profit organization primarily devoted to conducting research, and to disseminating the results of research, on the triggers of autism and on methods of diagnosing and treating autism.

“Vaccinations: Parents’ Informed Choice” at the Weston A. Price Foundation Web site

On the vaccines are safe and the risks are overblown side:

“Sticking Up for Thimerosal: Read the Studies – It’s safe.” By Arthur Allen on Slate.com

“How to Think About Vaccination - My Perspective” by Arthur Allen, journalist and author of
“Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver.”

Other scientific reports and informational Web sites:

Centers for Disease Control and Prevention’s vaccine safety web page

Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health.

Table of thimerosal content in some US-licensed vaccines

“Thimerosal exposure in infants and developmental disorders: a retrospective cohort study in the United kingdom does not support a causal association.” Pediatrics 2004; 114 (3)

“Mercury in Vaccines Is at Safe Levels, Study Suggests” University of Rochester Medical Center

“Safety of thimerosal-containing vaccines: a two-phased study of computerized health maintenance organization databases.” Pediatrics 2003; 112(5) …..tics

“MMR and Autism: Suspect or Superstition?” Pediatric Bulletin

“A two-phased population epidemiological study of the safety of thimerosal-containing vaccines: a follow-up analysis.” Medical Science Monitor

“Influenza-Associated Deaths Reported Among Children Aged <18> From Morbidity & Mortality Weekly Report

And then some reactions from health care professionals I contacted:

Melissa Terry Flynn, certified nurse-midwife:

I had never had a flu shot until I came here to Columbus and our practice pretty much requires everybody to take one. I have never had a problem taking it. I did have the flu once about 20 years ago and just remember feeling like I was dying and being thankful that I didn't have anybody to take care of. As a mother of young children I would probably get one unless you intend to stay holed up for the next six months. You don't have the option of going to bed for a week. There is also a FluMist for kids over age 2 that doesn't seem to have the preservatives that the shot has that you might find better for Will. Read about it online and see if your pediatrician will order it. It is a live virus vaccine but early studies look better than the shot in young children.

Our pediatrician, Richard Mansfield (additional reaction is in the column):


On FluMist: We do not have Flumist in our office this year due to inadequate demand. People balked at the extra cost. In addition, you have to be perfectly healthy. New data this year suggests that it lasts longer than the shot. The shot, if given early in the season may not be effective in February. Flumist is also a live virus and as such can give a flu like illness.


On Vaccines and autism: I have great empathy for parents dealing with special needs children. Every day can be a struggle. Many times we do not know what caused the disability. What I see written by blog writers and nonimmunizers is that they base their decisions on emotions or anecdotal reports. This is perhaps the way medicine was practiced centuries ago before we conducted double blinded randomized controlled trials. We as parents and physicians do our duty when we make decisions for our children based on sound science. Keep in mind that the cause of autism is unknown. The leading theory is a genetic defect. There is NO association with vaccines and autism.

Jennifer Fletcher, Registered Nurse and International Board Certified Lactation Consultant:

I think that for children over the age of two, a flu shot is probably a pretty good idea. Please know, however, that the thimerosal issue is very real and must be considered on an individual basis.I personally know of one case in which a child had seizures and eventually died at the age of sixteen months, after receiving her MMR. This child does not live in the Columbus area but was the niece of one of my breastfeeding clients. My client has decided to postpone ALL vaccinations for her child until she reaches the age of two and then vaccinate very slowly---none of those four to six injections at a time!Personally, I think that the effects of thimerosal, as with all heavy-metal containing substances, are dose-related. It might be that routine vaccinations PLUS flu shot might be too much, whereas one or the other might be fine.This is a very complex issue, and there is no one "one size fits all" answer. Who really knows what vulnerabilities our children might demonstrate? But for a child who is in close contact with others outside their families (day care, church nurseries, play groups, etc.) a flu shot may well be warranted for those over the age of two.

Arthur Allen (author of "Vaccine"; additional reaction is in the column):

On thimerosal: The data are clear on thimerosal. It does not cause harm. But that's a very long story. Perhaps it's easiest to point the following out: the ethyl mercury contained in a single flu shot that an a child over 3 years of age would be getting has approximately one sixth the ethyl mercury that was in the three DTP vaccines that children got between 1942 and 1992 or so, when the HiB and hep B shots were added … The data clearly show that the numbers of autistic kids continued to go up after thimerosal was removed from all shots except flu. In other words, the levels of thimerosal were back far below what they were in 1960, say -- but the autism rates continued to be 1 in 150 or whatever. Look at the California DDS statistics if you want more precision. You know, organic mercury is present in tiny amounts in the air we breathe and many foods we eat. Fish, for example -- a can of tuna has a dozen or so mcg of methyl mercury (check that, it's approximate), and even a head of lettuce, as I recall (from the book Quicksilver, I forget the author, 1972 or thereabouts) has 2 or 3 mcg of methyl mercury in it. We know that in massive amounts, mercury can cause all kinds of problems. But the only real data we have for harm from mercury in small, "natural" amounts comes from studies of seafish eaters. In one study, in the Syechelles, moms who ate lots and lots of mercury containing fish had kids who were smarter than the kids of moms who ate none. In another, in the Faeroes islands, there was some evidence of slight neurodevelopmental delays -- slower reaction on tests, slight attention deficits -- in the kids of moms who binged on pilot whale meat. These were massive consumptions, over time, of HG, but that was what EPA used to set its threshold--to be on the safe side. Bottom line is, even if thimerosal, in sufficient dose, were a cause for concern, that dosage is no longer given to kids.

Also, I'm sure you're aware of the fact that multiple studies done since 1999 (and since Stephanie Cave's alarmist and in my opinion worthless book came out) have shown no harm from thimerosal.The costs of vaccines are always exaggerated by anti-vaccine activists like stephanie cave. It of course makes sense to weight the costs and benefits of anything you do. But word to the wise: don't trust people like Stephanie Cave to make that equation for you.

On giving multiple shots at one time: The question is, what's the basis for concern about the multiple shots? Is there anything real, other than a gut unease about "all those shots?" cumulatively, kids get exposed to fewer antigen particles in vaccines than they did in the 1970s, because the DPT vaccine has a more purified pertussis component than the old one did, and they no longer get smallpox vaccine. Kids are exposed to multiple germs every day. Vaccines are just visible, that's all. I understand the fears -- kids hate shots, parents hate to see their kids suffer, it's a hassle and bother, and whenever the specter of harm arises in a substance that doesn't seem necessary at the time, we naturally shy away from it. But on the basis of rationally trying to protect our kids, none of the vaccine critics' points really stick.


On the flu vaccine: The thing about flu vaccination is this: old people have been trained to get their flu shots, and that's fine. But the fact is, even though cumulatively flu vaccine helps protect the elderly from flu, on an individual basis an old person's immune system has often deteriorated in a way that doesn't allow them to provide a good immune response to the shot. So they don't get that much beneift from it. The best way to protect old people from flu, it turns out, is to vaccinate their grandchildren and children. Ironically, although flu is not often deadly in the young--so their direct benefit from it may not seem that high -- in protecting the young we also protect the old. This is the concept of herd immunity. It's real.On vaccine safety in general: It's also important, in my view, to understand that many anti-vaccinators have a vested interest in alternative medicine that sways their understanding of these issues. There have been vaccine disasters in the past. But vaccines are safer now than they ever have been – I say this as someone who did a careful study of them for a book that took me 7 years to complete -- and the diseases they prevent are real.

If you're in a polling mood, go to the bottom of the October 11 "Flu shot" post and let us know whether you'll be opting for a shot this year, or whether you're still deciding. Or just leave your comments here.