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By Theresa Tamkins of Reuters
Health
When Christine Ewton's 18-month-old son Noah cried
on and off for two days after getting his hepatitis B vaccination it was
the final straw. Although her two oldest children, aged 16 and 13, had
been fully vaccinated, this Jacksonville, Florida mom made a decision -- no
more vaccines for either Noah, or her 5-year-old.
"I had a sick feeling and I remember the doctor
gave me the information sheet on hepatitis B as they were giving him the
shot and I'm reading through it thinking -- most at risk; homosexuals, prostitutes -- why
are they giving this to an infant?" she said.
"It didn't make sense to me." And it wasn't
just hepatitis B. She spent a lot of time reading books and searching
the Internet, combing well-recognized sites, such as those from the Centers
for Disease Control and Prevention (CDC) and the Food and Drug Administration
(FDA), and those with official-sounding names but murkier backgrounds.
What she found prompted her to make a decision.
No more shots of any kind for
her children.
Ewton had a problem, however. Because vaccines are
required before a child can enter school, what could she do? Again the
Internet was a savior. She was quickly able to find a site that guided
her through the process for filing for a religious exemption for her son.
"It was on the Internet and it was very accurate because he's in
kindergarten without the boosters," she said.
Ewton is not alone. Many
parents, it seems, are questioning vaccines, although not all
are choosing Ewton's route. According to 1994-1995 data from 40 states
reported to the CDC, about 0.5% of parents in the US file for vaccination
exemptions, citing medical, religious or philosophical reasons, although
the number is as high as 2.5% in some states.
However, it does seem that if they do have questions,
an increasing number of antivaccination websites are willing to give parents
an opportunity to chat with like-minded individuals, download information
and provide legal guidance on filing exemptions.
"I have noticed that there has been a tremendous
increase in sites in different parts of the world and it seems to be spreading
quite significantly," said Dr. Laeth Nasir, who published a recent
study on the subject. "When I looked initially I found about 50 sites,
my impression would be that that has probably doubled," said Nasir,
an associate professor of family medicine at the University of Nebraska
Medical Center in Omaha.
INCREASE
IN VACCINES LEAVES PARENTS WARY
Vaccines have saved million of lives and prevented
untold suffering that could have been caused by polio, diphtheria, whooping
cough (pertussis), measles and mumps. While previous generations kept
their children home during outbreaks of common childhood illnesses, parents
today have no such fears.
So why are people seemingly
more skittish about vaccination?
One possibility is an increasingly complex injection
schedule and the addition of new vaccines, said Nasir. In recent years,
vaccines for pneumococcus, haemophilus influenzae B, hepatitis B and chickenpox
have been added.
A vaccine for rotavirus -- the most common cause
of severe childhood diarrhea -- was added in 1998, then withdrawn from the
market in 1999 after it was found, in rare cases, to cause intussusception,
a type of bowel obstruction. "It's my sense that there has been quite
a bit of change in the past 10 or 15 years in the vaccination schedule
and I think any time there is change, there is a feeling of instability,"
he said. "I think with the rapid change of pace in everything people
are just naturally a little bit more suspicion," he said.
"Coincident with this there has been a decline
in the people feeling that its their civic duty to absorb some risk for
the good of everybody, those two things have happened in tandem and it's
made sort of toxic mix." Ewton remembers thinking that her 5-year
old seemed to be getting more shots than her teenaged children had received
at the same age.
"That kind of concerned me that they kept adding
more that my other ones did fine without. But still you think, of course,
they wouldn't do anything that wasn't needed or necessary -- you don't question
it," she said. It wasn't after the rotavirus vaccine was recalled
that Ewton began to troll the internet in earnest, looking for answers.
VACCINE
INFORMATION: TRUTHS, HALF-TRUTHS AND MORE
But who can a parent trust? Ewton turns a jaundiced
eye on all the information she gets from the Internet, even well-respected
websites, including those from the CDC and FDA. She notes that the CDC
has said that about 100 people die every year of chickenpox. Thinking
that those numbers referred to children, she was surprised to find out
that only 23 of those deaths were in individuals under the age of 19,
while the remainder were in adults.
"Seems like they can twist it for whatever
picture they want to portray," she said. There's no question that
the avalanche of material; available to parents can be overwhelming, and
that some sites can foster paranoia and suspicion.
Nasir found 51 antivaccination
websites in his study, and closely examined 26 of the sites. Almost all
of the sites made an effort to appear unbiased about vaccination, he said.
"There's a whole range of just insane kind of stuff -- vaccines are
being put out by a group of people to take over the world -- to very sophisticated
websites, and I think these are the most dangerous ones really,"
Nasir said.
Fifteen of 26 sites advocated the use of alternative
medicine over vaccines to prevent or treat illness. Such theories are
similar to objections of antivaccination groups from as far back as the
19th century, Nasir said.
"So if you hear that statistic and you don't
understand the rest of it, it is quite anxiety-provoking." Some websites
say that doctors were at best ignorant and at worst, purposely exaggerate
the dangers of vaccine-preventable illnesses to push parents into complying.
Other say that pharmaceutical companies were in cahoots with doctors and
the medical establishment to make money from vaccination. And a report
from the US House Committee on Government Reform released on August 23
isn't helping the situation. The group lambasts FDA and the CDC for allowing
scientists with financial ties to industry to sit on their respective
vaccine advisory committees. "This report again confirms what I have
been reading on some of the controversial vaccine sites, that money is
the motivating factor behind the push for vaccines, especially the recent
ones," Ewton said. "It makes me sick to my stomach to think
that my child is so "statistically unimportant" that vaccines
are approved so casually with little regard to our children."
DO
EXEMPTIONS PUT OTHERS AT RISK?
Even if none of the information on such sites is
true, some parents feel that even the commonly accepted -- albeit relatively
rare -- vaccine risks, such as prolonged crying bouts or fever, are unacceptable.
Their theory is that such vaccine-preventable illnesses are now so rare,
that the risks outweigh the benefits. Or, even if such illnesses do strike,
modern medicine can somehow combat the symptoms. However, there are no
effective drugs or treatments for many vaccine-preventable illnesses,
including polio and measles.
"In 1990, there was a major outbreak of measles
in the US with about 55,000 cases and over 120 deaths," Schwartz
said. "In an investigation of measles cases in California that occur
during that time, people who were not vaccinated, the philosophical exempters,
were significantly more likely to become ill." He also notes that
in communities with a higher number of people with philosophical exemptions
to vaccination, children -- even vaccinated ones -- were more likely to get
sick than those in communities with few philosophical exemptions. Even
children who receive every recommended shot may not be 100% protected
against an illness.
Having as many people as possible in society vaccinated -- limiting
the amount of illness circulating in society -- can provide the additional
insurance against getting sick, Nasir said. "Certainly people who
are opting out for their own selfish reasons increases everybody's risk,
and that is something that people need to look at and decide what kind
of action they want to take," he said.
PUTTING
PARENTS AT EASE
Regardless of the potential benefits to society,
it is still every parent's personal choice whether or not to vaccinate.
Could the medical community be doing more to convince parents that vaccination
is just as important now as when they were children? Vaccine experts may
need to think more carefully about how new vaccines are introduced, Nasir
said.
"Mainstream medicine is doing it in the best
interest of science; every time we get a new vaccine we twiddle things
a bit to makes things a little better, a little easier," he said.
"But there is a downside; perhaps we'll provoke anxiety that will
counterbalance the good things we do." Pharmaceutical companies are
now working on combination vaccines to at least reduce the number of shots
youngsters need to have, Schwartz said.
However, that could take time. "I'm a parent,
I have a young child and if the choice is between them getting another
shot or them getting pneumococcal meningitis or pneumococcal pneumonia,
clearly getting another shot is the best choice," he said. Overall,
parents need to weigh all the information and make an informed choice
about vaccinating their children Schwartz said.
"I think if a parent truly has a religious,
medical or a philosophical issue, then that's why the exemptions are there,
but if they are being encouraged to use that exemption because they are
concerned about vaccine safety I would encourage them to learns the truth
about vaccine safety issues," he said.
Reuters
Health September
1, 2000 (http://www.reutershealth.com)
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