I feel like starting a vaccine debate

anna7602 · January 2012

Ok, not really a debate, but more of a spirited discussion on how the guidelines are set? I got some flack on the boards for following an alternative schedule early on, although no one IRL seemed to particularly care, including our pedi. DD is all caught up now, so flash forward to today.

I went into the pedi so he could fill out the mammoth forms I need for DD to start school in France this month. We both noticed that the shots (boosters for MMR, Dtap and 2 more I can't remember right now) she would normally be due for at her 4 year appt (this May) aren't administered until age 6 in France, per the form I was given by the appropriate gov't ministry. So, I asked the pedi what to do, go in with a list anyway to a pedi in France or just wait until we return next January? He said to just wait and that there's no compelling medical reason to do the boosters at age 4. It's just what is convenient for the American school system because it's just before most kids start public school. If I decide to stay in France until the end of next school year (age 5 for DD), then it doesn't even matter. But, if I return in January and put DD back into pre-K here right away, then I have to be sure to get the shots as soon as we return.

So, she will be in school and around other kids the whole time, but from a public health perspective, it seems that when these particular boosters are given is just an administrative issue?

Discuss.

SandiaPinaMama · January 2012

Yes, it does seem as though the schedule is a bit reliant on what is convenient for paperwork reasons. Except that wouldn't it make sense to booster the kids before we cram them en masse at school?

Still free to be me · January 2012

Well, I've actually read that it is more effective to vaccinate adults for certain diseases, but it is easier to actually get kids in to get the vaccines...so, they make that the requirement because compliance is more likely...So, yeah, I think a lot of the schedule is developed based on convenience for paperwork...

sucredee · January 2012

Actually, the CDC schedule here is between the ages of 4-6. I am a PA and usually don't give them at 4 and wait until kids start kindergarten when the schools require it. I would just hold off until you come back. It sounds like she wouldn't be starting kindergarten if you come back in January so they wouldn't be required yet anyway. And yes it is mostly an administrative issue, technically she can wait until 6 according to the CDC schedule

ncbelle · January 2012

Sounds administrative to me! But I think that's the same reason Hep B starts at birth - easier to give something that requires 3 rounds to an infant who you will be seeing on a regular basis...

ILoveRunning · January 2012

ncbelle:
Sounds administrative to me! But I think that's the same reason Hep B starts at birth - easier to give something that requires 3 rounds to an infant who you will be seeing on a regular basis...

This. When I was interviewing potential pediatricians we talked about immunizations, alternative schedules, etc. One pediatrician told me that the one of the big reasons our (the CDC) schedule is as compact as it is, is to vaccinate as many individuals to the greatest extent possible. It really is an issue of public health and not individual health.

She also went as far as to say that they would never give a vaccine to any kid in her practice if there were any sign of illness (the office is in a fairly affluent area), but when she worked at a free clinic for low income families, their policy was to vaccinate, even if the kid had a fever, because of how difficult it would be for most caregivers to make a new appointment.

tokenhoser · January 2012

The thing is you have to set up a sort of arbitrary schedule - it doesn't really matter if you do it at 4 years or 6 years, but it matters that it gets done. It's much easier to track if the CDC just makes a decision and gives everyone the goal of getting shots at certain ages.

We don't do Hep B in Canada until kids are in school. I don't think there's any huge risk to delaying that, but there is a risk if people just never get it done because they decide to go their own way. Delaying vaccines is fine (if you're okay with leaving your child exposed to those diseases for weeks/months at the point in their life where they are most vulnerable to serious complications), but if every kid is on their special snowflake schedule, it gets harder to figure out who is missing what. It's fine if you're a on-the-ball parent with a plan, but not all parents are like that. In fact... most probably aren't.

noonecarewhoiam · January 2012

ncbelle:
Sounds administrative to me! But I think that's the same reason Hep B starts at birth - easier to give something that requires 3 rounds to an infant who you will be seeing on a regular basis...

No, the reason Hep B is started at birth is because of the very high risk of vertical (mother to child) transmission, which can be nearly negated by immediate vaccination. Obviously not an issue of the mother is Hep B negative, but if her status in unknown, it's critical.

In many areas of the world, Hep B prevalence nears 15%, with mother-to-child transmission the primary route of infection. Globally, Hep B is the 8th leading cause of death and the leading cause of primary liver cancer.

Stef6385 · January 2012

noonecarewhoiam:
ncbelle:
Sounds administrative to me! But I think that's the same reason Hep B starts at birth - easier to give something that requires 3 rounds to an infant who you will be seeing on a regular basis...

No, the reason Hep B is started at birth is because of the very high risk of vertical (mother to child) transmission, which can be nearly negated by immediate vaccination. Obviously not an issue of the mother is Hep B negative, but if her status in unknown, it's critical.

In many areas of the world, Hep B prevalence nears 15%, with mother-to-child transmission the primary route of infection. Globally, Hep B is the 8th leading cause of death and the leading cause of primary liver cancer.

Ok, you kind of make sense, but not really. I am not going to even comment on your worldly stat, but I'll focus on the US. Here's my issues, yes HBV can be passed to an infant at birth which can cause chronic liver problems, but this vax shouldn't be routine. Mothers are tested before birth for HBV. If they are positive, then yes get the shot, but if they are negative this shot is not critical in the first days of life. And to say the vax will work immediately? Then why are there three doses of the HBV shot in the subsequent well visits? Immunity will not instantly happen with one shot, will it?

From the reading and research I have personally done, which everyone who vaxxes should have done as well, I have found the CDC's strategy of the routine HBV shot. Here it is:

https://www.cdc.gov/mmwr/preview/mmwrhtml/00033405.htm

And I quote:

" Immunization with hepatitis B vaccine is the most effective means of preventing HBV infection and its consequences. In the United States, most infections occur among adults and adolescents (2,3). The recommended strategy for preventing these infections has been the selective vaccination of persons with identified risk factors (1,2). However, this strategy has not lowered the incidence of hepatitis B, primarily because vaccinating persons engaged in high-risk behaviors, life-styles, or occupations before they become infected generally has not been feasible. In addition, many infected persons have no identifiable source for their infections and thus cannot be targeted for vaccination (2)."

"Efforts to vaccinate persons in the major risk groups have had limited success. For example, programs directed at injecting drug users failed to motivate them to receive three doses of vaccine (CDC, unpublished data). Health-care providers are often not aware of groups at high risk of HBV infection and frequently do not identify candidates for vaccination during routine health-care visits (CDC, unpublished data). In addition, there has been limited vaccination of susceptible household and sexual contacts of HBsAg carriers identified in screening programs for blood donors (23). Hepatitis B vaccination of health-care workers appears to have resulted in a substantial decrease in the rate of disease in this group, but has had little effect on overall rates of hepatitis B (2). Moreover, to achieve widespread vaccination of persons at occupational risk, regulations have had to be developed to ensure implementation of vaccination programs (24)."

So, if I am reading this correctly, the CDC has said that the groups most at risk for HBV were not getting vaccinated, thus they recommended to have ALL newborns immunized at birth for HBV. Wow! How can you not question this vax after reading this. (I had to search very deeply to find this article because I know my doctor would not divy up this info to me). I also love how the CDC has all this unpublished data, haha! Might as well make stuff up, and feed it through the media. I, fortunately can think for myself, and do not rely on someone else to make a health decision for me or my family.

lanie30 · January 2012

Wow! How can you not question this vax after reading this. (I had to search very deeply to find this article because I know my doctor would not divy up this info to me). I also love how the CDC has all this unpublished data, haha! Might as well make stuff up, and feed it through the media. I, fortunately can think for myself, and do not rely on someone else to make a health decision for me or my family.

This makes you sound exceptionally ignorant. You found "unpublished data" on the CDC's website? Where it was... published? it makes legitimate and appropriate sense to vaccinate babies in ordert o prevent the continued spread of a disease in the adult community with whom that baby will likely be interacting. You can choose to not vaccinate your child at birth if you like, but sweeping the CDC with a "dumbo" label for something you can't quite grasp yourself using google, is silly.

I was told to vaccinate Jo at birth because J was born in the philippines. however because J had been here for over 18 years, was a nurse and was routinely screened for all sorts of things, we opted out. But she will have the vaccine when she is 11 when it is dispensed in 7th grade at school with her colleagues.

Different countries must and SHOULD have different schedules. this doesn't negate a schedule of another country or make other public health units more "enlightened." it simply reflects (as it should) the differences in illnesses, exposures and rates of disease in the populations. in fact, here we have provincial standards because clearly, living in Nunuvut brings different public health challenges than living in Toronto. Its just smart.

J was immunized against TB. we don't do that here. The schedule we have with Canada says that the boosters should be givenb etween 4 & 6. I think its important to get them at 4 because she's at daycare and will be starting school this fall.

Bride2b2004 · January 2012

noonecarewhoiam:
ncbelle:
Sounds administrative to me! But I think that's the same reason Hep B starts at birth - easier to give something that requires 3 rounds to an infant who you will be seeing on a regular basis...

No, the reason Hep B is started at birth is because of the very high risk of vertical (mother to child) transmission, which can be nearly negated by immediate vaccination. Obviously not an issue of the mother is Hep B negative, but if her status in unknown, it's critical.

In many areas of the world, Hep B prevalence nears 15%, with mother-to-child transmission the primary route of infection. Globally, Hep B is the 8th leading cause of death and the leading cause of primary liver cancer.

According to my OB, the CDC requires all that all mothers be tested for several diseases/immunity levels prior to birth (including Hep . So there is typically no "unknown". Even though I became pg when DS2 was only 10mo old and I had JUST done all b/w, I had to redo it 10 mo later when I became pg with DS3. In the hospital, they tested (again) for Hep B (again, negative). They know there no no possibility for vertical transmission in most cases, but in my experience still advocate immediate vaccination.

x0stephanie · January 2012

tokenhoser:
The thing is you have to set up a sort of arbitrary schedule - it doesn't really matter if you do it at 4 years or 6 years, but it matters that it gets done. It's much easier to track if the CDC just makes a decision and gives everyone the goal of getting shots at certain ages.
We don't do Hep B in Canada until kids are in school. I don't think there's any huge risk to delaying that, but there is a risk if people just never get it done because they decide to go their own way. Delaying vaccines is fine (if you're okay with leaving your child exposed to those diseases for weeks/months at the point in their life where they are most vulnerable to serious complications), but if every kid is on their special snowflake schedule, it gets harder to figure out who is missing what. It's fine if you're a on-the-ball parent with a plan, but not all parents are like that. In fact... most probably aren't.

Hep b is included in the combo shot for 2-4-6 mo olds in BC

tokenhoser · January 2012

x0stephanie:
tokenhoser:
The thing is you have to set up a sort of arbitrary schedule - it doesn't really matter if you do it at 4 years or 6 years, but it matters that it gets done. It's much easier to track if the CDC just makes a decision and gives everyone the goal of getting shots at certain ages.
We don't do Hep B in Canada until kids are in school. I don't think there's any huge risk to delaying that, but there is a risk if people just never get it done because they decide to go their own way. Delaying vaccines is fine (if you're okay with leaving your child exposed to those diseases for weeks/months at the point in their life where they are most vulnerable to serious complications), but if every kid is on their special snowflake schedule, it gets harder to figure out who is missing what. It's fine if you're a on-the-ball parent with a plan, but not all parents are like that. In fact... most probably aren't.
Hep b is included in the combo shot for 2-4-6 mo olds in BC

Grade 6 in SK. Are you sure you don't mean HiB? That's different.

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