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Sunday, September 28, 2008

"Vaccine Decisions" by Charlotte Moser, Assistant Director of the Vaccine Education Center at The Children’s Hospital of Philadelphia

By Charlotte Moser

I am a mom, but I also happen to be a mom who spends my days thinking about vaccines. After college, I began working in a research laboratory where we were conducting studies to try to better understand how rotaviruses infected the cells of the intestine, so that vaccines being developed would work most effectively. At the time, you didn’t hear much about vaccines in the news. However, as time went on, we realized that people were not necessarily happy about new vaccines that were being developed nor did everyone have confidence in the safety of vaccines. Because we studied vaccine science, we created the Vaccine Education Center at The Children’s Hospital of Philadelphia. One of our goals was to provide a place where people could get answers about vaccines that were based on strong science. That meant studies that were well-controlled and reproducible.

Although the Center officially began in the fall of 2000, I remember our first discussions several months earlier. In fact, the conversation that formalized our plan occurred as I prepared to return from maternity leave for my second child. This issue was on my mind as a mom, and I welcomed the opportunity to explore it more in-depth. Each time that I took my infant for another round of immunizations, the safety questions that we were hearing rang loudly in my mind. The benefit was that I had experts around me whenever I had a question and many of the questions were ones that others had asked and we had studied. Emotionally, it did not make taking my infant to the doctor any easier, but I tried to remember the studies and focused not on the decision to vaccinate but rather on making my infant more comfortable during and after the shots. I also tried to remember that I was protecting my infant with the best science available.

Since the inception of our Center, the number of questions about vaccines has seemed to grow and so have my children- daycare entry vaccine requirements, kindergarten vaccine requirements and most recently, middle-school vaccine requirements. My kids know that I study vaccines, they hear me talk about the latest issues or see me trying to catch the latest news reports, but we still have those times right before we go to the doctor when I have to remind them and myself why they must get their vaccines.

I have been invited to answer vaccine questions herein and I hope that when you read the questions and answers below, you will remember that I am a mom too and I am not trying to forward some party-line. My kids get every vaccine that is recommended because I feel very strongly about protecting them the best way that I can.

What are the dangers of vaccines?
Most vaccines have some mild side effects, such as redness or soreness at the site of the injection or fever. As parents there are things that we can do to make them feel more comfortable after getting vaccines, such as providing pain relievers (as directed by the doctor), putting a cool compress on the area of the shot, giving a lukewarm sponge bath if fever develops, providing extra liquids in the 24 hours after vaccines, providing extra “tlc” and realizing that they may be less hungry or more cranky than usual.

Sometimes after a child gets a vaccine, they are diagnosed with some other condition. In these cases, parents have logically questioned whether these conditions were caused by the vaccine. When these questions arise, scientific studies are conducted because although a personal experience is captivating, it does not prove causation. To determine if condition “X” was caused by the vaccine, scientists compare children who did and did not receive the vaccine. If the vaccine caused condition “X,” significantly more children who received the vaccine will have the condition than children who did not receive the vaccine.

These types of studies have been done to determine whether vaccines caused diabetes, multiple sclerosis, arthritis, asthma, and most notably, autism. In all cases vaccines have been found not to cause these conditions.

Why are vaccines mandatory?
There are two words that are important to consider when talking about vaccine mandates. The first is required and the second is recommended.

When a vaccine is required, it is mandated. Said another way, the state government has determined that the vaccine should be available and given to all children in that state before they enter daycare or a specific grade in school. The decision to require a vaccine is based not only on the health of the children in the state, but also on the financing available. If the state requires that a vaccine be given, lawmakers must also make sure that they can provide the vaccine for children whose families otherwise couldn’t afford it.

Recommendations come before requirements and are determined at the federal level. These decisions are driven by medical considerations; experts study the amount of disease present in the community, the age groups of the population who are most at risk, other vaccines given to this same age group, and how the vaccine worked in the clinical trials (studies of the vaccine during its development). As a mom, the vaccine recommendation is more important to me personally. I want my children to have any vaccines that are available even if they are not required (mandated). For example, the influenza vaccine is not required in every state, but it is recommended for all children 6 months to 18 years of age. Another example is the meningococcal vaccine, which is also not required in every state.

When communicable diseases were common, mandates decreased the spread of disease. Some of today’s newer vaccines are less easily transmitted in a classroom setting, so there has been somewhat of a backlash against mandates; however, public health officials who believe in the importance of vaccines know that mandates have worked to protect people before and continue to rely on them as tools for protecting those in their communities. Likewise, mandates are needed to get vaccines to those children whose families may otherwise not be able to afford them.

Why not space out the vaccines?
When vaccine recommendations are made, one of the considerations is when to give a vaccine. A vaccine will only be protective if the recipient gets it early enough to generate a protective immune response before being exposed to the disease. While maternal antibodies protect a baby in the first few months of life, they begin to diminish as the first year of life progresses. When this happens, babies become susceptible to diseases that previously they would not have. If vaccines are spaced out, the baby may come into contact with one of the diseases in the meantime.

When making recommendations, scientists and doctors must consider the existing immunization schedule and the safety of giving these vaccines together. Likewise, when a company is making a vaccine, it is required to do the studies at the time the vaccine is likely to be given, so that any effects on existing vaccines in the schedule or vice versa can be determined. All of this means that before a vaccine is added to the schedule, many different groups of people have studied the data and considered whether it is safe to add to the schedule at that time. In addition to a longer period of susceptibility, spacing out vaccines arbitrarily is more dangerous because each person’s individual schedule has not been studied.

Charlotte Moser is the assistant director of the Vaccine Education Center at The Children’s Hospital of Philadelphia. She has extensively published in scientific journals on the topics of immunology and virology. Through her research, Ms. Moser has contributed to our understanding of how vaccines prevent infections of the intestinal tract. She has also developed a novel method to enhance immune responses to vaccines. Ms. Moser is the creator of Parents PACK, a program established to develop a dialogue about vaccines with parents through a Web site and monthly email newsletters. The Parents PACK can be found at www.vaccine.chop.edu/parents. The Web site of the Vaccine Education Center is www.vaccine.chop.edu