The question I am asked by parents more often than any other is, “Should my child be immunized?” It is a question they should be asking given the conflicting reports and recommendations they are reading and receiving. The deepest desire of any parent should be to protect his or her child from harm.

I still recall the concern in my parent’s voices and the anxiety on their faces each time they learned that another neighboring child had contracted polio. I saw other children in braces and saw pictures of people lying helplessly in “iron lungs” and tried not to think of the possibility that I too could succumb to the disease.

One summer my classmates and I met at our country schoolhouse where we were loaded into cars and taken to the big school in town. There we stood in line to receive shots. We didn’t appreciate the injections, but from that point forward no child in our community came down with polio and everyone breathed a collective sigh of relief.

That experience, coupled with my unpleasant memories of days spent in bed with measles, German measles, and other childhood illnesses kept me from questioning the wisdom of immunizing my daughters. Times change, however, and questions about the wisdom of immunizing children and adults against disease are being raised in many quarters.

A cursory Internet search for immunization risks finds articles suggesting that childhood immunizations are linked to dramatic increases in asthma, allergies, learning disabilities, autism, attention-deficit disorder, diabetes and other chronic neurological or autoimmune diseases. On the other hand, the United States Centers for Disease Control, the American Academy of Pediatrics and the American Academy of Family Physicians strongly support aggressive childhood immunization programs.

I am convinced that parents asking the question, “Should my child be immunized?” are seeking what is in the child’s best interest. They do not want to expose their infants or children to real and immediate dangers in order to decrease their risk of contracting a disease most have never seen. When one reads an editorial reporting that between 12,000 and 14,000 children are injured or die from immunizations each year it is reasonable and responsible to ask the question, “How many children died of diphtheria, polio, or measles last year?”

Parents asking questions about childhood immunizations are not saying that they don’t want their children protected from serious illnesses, but they are unwilling to accept a casual response from the proponents of immunization programs be they physicians, nurses, or public health authorities. They want to know that their concerns are being heard and that the person recommending that their child be immunized has read the same articles they have read and that he or she has seriously researched the questions raised.

Parents are justified in refusing to blindly accept recommended immunization schedules, but they should also challenge the statements of those who oppose immunization. The editorial mentioned above, which is posted on the Internet, claims that between 12,000 and 14,000 children are injured or die from immunizations each year, but is the statement accurate?

In a word, no. The author is either displaying deplorable ignorance or applying willful deceit to make her point. The truth is that the 12,000 to 14,000 figure does not represent documented immunization injuries or deaths, but rather all reported incidents surrounding the time of immunization, whether related to or totally coincidental to the vaccine.

The National Childhood Vaccine Injury Act of 1986 created a reporting system called the Vaccine Adverse Events Reporting System (VAERS). Anyone can report changes in a child’s condition following an immunization. Reporting the presence of a symptom does not constitute proof of vaccine injury, simply that something occurred within hours, days, or even weeks of the immunization.

For example, if a child received an immunization and was subsequently exposed to and developed a strep throat infection with fever and rash the event could be reported to the VAERS. The reporting of a fever and rash occurring following the immunization would not, in this case, indicate that the child was injured by the vaccine, yet that is what those quoting VAERS statistics claim. Many further inflate the figures by making unsubstantiated claims that “Less than 10 % of vaccine related injuries are actually reported, perhaps as few as 1 %.”

Vaccination injuries do occur, but many, if not most, of those reported involve low-grade fevers of 100 degrees or less and local reactions to the injection, such as redness or swelling, that resolve without complication. The risk of a serious allergic reaction to most vaccines is less than one in a million doses. The incidence of death from immunization is so low that it cannot be calculated.

The MMR immunization can trigger a temporary decline in the number of platelets, which are responsible for plugging leaks in the circulatory system, in 1 in 30,000 doses. A temporary arthritis can also occur. This occurs in about 1 of 4 adult women given the vaccine, but is rare in children.

The pertussis (whooping cough) vaccine carries the greatest risk of significant reactions. Although the newer, acellular pertussis vaccine is promoted as being safer than the older whole pertussis, a fever of 105 degrees or greater occurs in 1 in 16,000 doses, prolonged crying indicative of brain inflammation in 1 in 1,000 doses, and a seizure or convulsion in 1 in 14,000 doses.

These risks must be weighed against those of failing to immunize, however. Prior to the availability of the pertussis vaccine over 200,000 cases of whooping cough, accounting for 8,000 deaths, were reported in the United States each year. Some argue that we live in a different time, and that the low incidence of the disease today coupled by the availability of antibiotics to treat it has negated the need to continue to immunize against it.

History, however, does not support this argument. In the 1970s three countries - Great Britain, Sweden, and Japan - cut back the use of pertussis vaccine because they felt the risks outweighed the benefits. The results were dramatic and immediate. In Great Britain, a drop in pertussis vaccination in 1974 was followed by an epidemic of more than 100,000 cases of pertussis and 36 deaths by 1978. In Japan, around the same time, a drop in vaccination rates led to a jump in pertussis from 393 cases and no deaths in 1974 to 13,000 cases and 41 deaths in 1979. In Sweden, the annual incidence rate of pertussis per 100,000 children 0-6 years of age increased from 700 cases in 1981 to 3,200 in 1985.

One of the concerns raised most frequently by those asking me about the wisdom of immunization is that of autism. Vaccine detractors point to a rise in the incidence of autism in recent years and argue that a large number of cases have presented within a few days of the child receiving a measles or MMR immunization.

Since autism is a devastating affliction with no known treatment a relationship with immunizations, if present, is a cause for serious concern. While direct evidence for such a link is not present, there is a plausible mechanism by which acetaminophen given in conjunction with vaccines could lead to autistic disorders  (See Autistic Disorders:  A Preventive Strategy).  

The MMR – autism link theory appears to have originated when researchers reported a possible link between the measles virus and inflammatory bowel disease in the early1990s. This proposed link has not been borne out by other researchers, and investigation of the MMR – autism connection has not demonstrated any relationship.

For example, large studies in the United Kingdom and California demonstrated that while the incidence of autism increased nearly fourfold between 1980 and 1994 the incidence of measles immunization remained unchanged. A study in Sweden clearly demonstrated that the incidence of autism did not change when the MMR immunization was introduced.

In addition, a study of all children born in Denmark from January 1991 through December 1998 was published in 2002. There were a total of 537,303 children in the study; 440,655 of the children were vaccinated with MMR and 96,648 were not. The researchers did not find a higher risk of autism in the vaccinated than in the unvaccinated group of children. There was no association between the age at time of vaccination, the amount of time that had passed since vaccination, or the date of vaccination and the development of any autistic disorder.

The number of available immunizations has risen significantly over the years, however, and there appears to be cause for concern regarding some of the newer immunizations. The HiB (hemophilus influenza B) immunization, for example, has been demonstrated to significantly increase the risk of developing insulin dependent diabetes.

While the connection between the HiB immunization and Type 1 diabetes has been discounted by many, J. B. Classen reported in July, 2002, that 54 additional cases of Type 1 diabetes are found for every 100,000 children who receive the series of 4 HiB vaccinations. These cases appear in clusters from approximately 38 to 46 months following immunization. The immunization has also been shown to trigger diabetes in mice, presumably through an autoimmune mechanism.

Interestingly, when an infant receives an immunization at birth, the incidence of childhood diabetes appears to decrease. This may be an advantage of the hepatitis B series, which is typically initiated at birth. The effect is not specific to the hepatitis B vaccine as it was initially demonstrated in Dutch children who had received an early smallpox vaccination, and hepatitis B series started at 2 months or later may increase the incidence of Type 1 diabetes.

What advice am I giving my daughters as they face the question of immunizations for my grandchildren? I am recommending that they consider what is currently known about the benefits and risks of each immunization as they relate to the children and act accordingly.

Diphtheria, pertussis, and tetanus are life-threatening diseases that could be contracted by an unprotected individual. Despite the potential complications of the pertussis component, I believe the benefits of DaPT immunizations far outweigh the risks. The same is true for the polio and MMR (measles, mumps & rubella) immunizations.

On the other hand, the increased risk of childhood diabetes following H-flu immunizations is well documented. I believe that the threat is real.

Hepatitis B is a blood-borne disease primarily associated with needle sharing during IV drug use and sexual promiscuity. If it is to be given the series should be started at birth. If the first immunization is delayed until the infant is 2 months or more of age I do not believe that it makes sense to take a chance of increasing the child’s risk of insulin dependent diabetes in the hope of protecting him or her from a consequence of high-risk behavior as a teen-ager or adult.

In contrast, there are currently no known significant complications associated with the hepatitis A immunization. Although hepatitis A is often thought of as a risk when traveling to underdeveloped countries, anyone eating away from home, whether at a communal luncheon or a restaurant may be unknowingly exposed to the hepatitis A virus. Therefore, protection from this disease is worth pursuing.

Haemophilus influenza is a disease that is most likely to strike infants who are spending time in day care settings or whose immune systems are compromised by poor diet or lack of appropriate supplementation. The benefits certainly outweigh the risks in day care children, but since my granddaughters are cared for at home and are well nourished, the risk of triggering diabetes through H-flu immunizations does not seem justified.

The chickenpox immunization appears to be safe. The disease can be managed very effectively in otherwise healthy children, but it becomes progressively more severe as age increases. In my opinion, the immunization is optional in young children, but should be given if a child has not had the illness and achieved natural immunity by the age of six. There is some preliminary data that suggests the risk of herpes zoster (shingles) in later life is lessened by receiving the vaccine. If this proves to be true the argument for the chickenpox immunization will be stronger.

The pneumoccal immunization has been introduced too recently to know what complications may result. I do not want my grandchildren to receive it at this time. The withdrawal of the much heralded rotavirus vaccine shortly after its introduction due to the risk of intrasusseption (the intestinal tract rolling back on itself)) emphasizes the need to proceed cautiously with new immunizations.

We do not live in a perfect world. Nearly every decision we face involves risks, regardless of the direction we choose. The immunization question is no different. The best course of action is to ask, “What is in the best interest of my child?” and act accordingly. The outcome may be less than what you desired, but you can face any consequence knowing that you made the best possible decision based on the information available to you at the time.