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)