Public confidence at risk in vaccine plan

By Anita Manning, USA TODAY

The government's plan to immunize hospital workers and others against smallpox could result in hundreds of side effects from the vaccine, including high fevers and raging rashes — and that could have an adverse effect on public confidence in all other vaccines, some experts fear.

"It's a real possibility," says Joseph Bellanti, professor of pediatrics and microbiology-immunology at Georgetown University Medical Center in Washington, D.C. "We have to guard against that by education, informed consent and better screening, so we can identify people at risk," he says.

Other immunization news Babies, in addition to getting all their other vaccines, should be immunized against flu, says the American Academy of Pediatrics in a policy statement issued Monday. The policy conforms with that of the federal Advisory Committee on Immunization Practices in encouraging, "to the extent feasible," flu shots for healthy children 6 months to 23 months, their family members and caregivers. Both the federal advisory committee and the academy recommend flu shots for children 6 months and older who have medical conditions that put them at high risk for complications of flu, such as pneumonia. For others, the vaccine is "encouraged," a distinction that is deliberate, says University of Maryland pediatrician Margaret B. Rennels, a member of the federal advisory committee and of the academy's committee on infectious diseases. "We didn't come out with a full recommendation," she says, "because we weren't sure (doctors) would be able to do it." With the holidays approaching, scheduling last-minute office visits might be difficult, and doctors might not be able to get enough vaccine or have enough staffing to immunize all the children in a practice. But the message for parents, Rennels says, is that young children need flu shots, just as their grandparents do. "The hospitalization rates associated with influenza infection in young children really equal the hospitalization rates of the elderly. The difference is kids don't die from it as often." While flu vaccine is still only "encouraged," that may change next year. The pediatricians' policy says the "ultimate goal is a universal recommendation for influenza immunization." By Anita Manning

A core group of American parents is convinced that the vaccines given to babies Monday play a role in the development of autism and a host of other ills. Mainstream medical experts, backed by reams of scientific studies, say that vaccines are generally safe and that they protect children from deadly diseases with few, if any, negative side effects.

At its heart, the debate is about risk — is it more dangerous to be vaccinated or to run the risk of contracting and spreading a contagious disease?

Most parents and many doctors have never seen the diseases vaccines prevent, such as measles, polio or diphtheria. Mary-Clayton Enderlein of Mill Creek, Wash., is an exception.

Twelve years ago, a week before she delivered son Colin, another mother, who didn't believe in vaccinating her children, stopped by with her little boy. He had a bad cough, which turned out to be pertussis (whooping cough). And even though Enderlein had been vaccinated as a child, she caught it, because her immune system was weakened by pregnancy.

Shortly after his birth, Colin got it, too. He was hospitalized for a week, and it's only because Enderlein is a nurse that she was able to bring him home that soon.

"He would cough and cough until he turned blue," she says. Babies with pertussis cough "30 or 40 times in a row, so they can't get enough oxygen. It's more than their little bodies can deal with," she says.

The infection made Colin susceptible to all sorts of illnesses in the first six months of his life, but today he's the picture of health, his mom says.

"I'm a big believer in the idea that you give people information and support their choices," Enderlein says. But people who choose not to vaccinate their children put their own families and others at risk, she says.

One potential danger is the use of live-virus vaccines, such as the oral polio vaccine. It is no longer used in the USA, because polio had been eradicated from the Western Hemisphere, and the only cases, about eight a year, were caused by the vaccine. They occurred mainly in infants with impaired immune systems or adults not fully immunized.

The smallpox vaccine also contains a live virus called vaccinia, which is similar to smallpox but not as dangerous. Still, it can cause problems, especially in people with weakened immune systems or a history of eczema. Experts estimate that if it's widely used, there could be thousands of illnesses and hundreds of deaths.

That's a dramatic contrast with vaccines routinely used today, says Walter Orenstein, director of the National Immunization Program at the Centers for Disease Control and Prevention in Atlanta. "With none of the current vaccines is there any risk of death," he says.

But some parents, doctors and others say routine childhood vaccines may carry risks of their own. "There has been a dramatic increase in chronic diseases as we've increased the number of vaccines," says Barbara Loe Fisher, president of the National Vaccine Information Center, a consumer group focused on vaccine safety.

Parents who believe their children have been harmed by vaccines have voiced their concerns from doctors' offices to Congress. Rep. Dan Burton of Indiana, whose grandson developed autism symptoms shortly after receiving a series of vaccines, has held public hearings on vaccine safety, and last week wrote to President Bush to urge him to host a White House conference on autism.

So far, vaccine rates remain high (about 77% of children receive the basic vaccines, say federal surveys), but health experts worry that public confidence is fragile.

Several studies have failed to find a link between vaccines and chronic health or developmental problems. The Immunization Safety Review committee of the Institute of Medicine (IOM), an expert body that advises federal policymakers, has produced reports on a myriad of vaccine safety questions: Does the measles-mumps-rubella vaccine cause autism? Does exposing babies to multiple immunizations harm their young immune systems? Is there a connection between multiple sclerosis and the hepatitis B vaccine?

In each case, the committee found no evidence of a link, but some parents remain unconvinced, believing that, at least for some children, vaccines may do more harm than good.

Sally Bernard of the advocacy group Safe Minds says thimerosal, a vaccine preservative that contains mercury, may be responsible for developmental disorders in children. The IOM, which looked at the issue, said there wasn't enough evidence to prove or disprove the theory. As of last year, thimerosal has been removed from most childhood vaccines, but Bernard says it shouldn't have been there in the first place. She says autism rates rose as the number of vaccines given to babies increased.

On Saturday, a study in the medical journal Lancet reported that mercury levels in infants who received vaccines containing thimerosal appear safely below health limits. Researchers in the Lancet study tested the blood levels of 40 infants for mercury following standard inoculations with vaccines containing the phased-out preservatives. All appear well below Environmental Protection Agency limits, the researchers say.

While no vaccine is perfectly safe or 100% effective, vaccines don't cause all the ills their critics say they do, says pediatric infectious disease specialist Paul Offit of the Children's Hospital in Philadelphia.

Known reactions to the pertussis vaccine, for example, are pain, redness and tenderness at the injection site, Offit says. In about one child per 10,000, it can lead to persistent, inconsolable crying, fever and seizures. But "none of those things cause permanent harm," he says, and the danger of being unprotected is significant. Pertussis still causes about 7,000 illnesses and 10 deaths annually.

In general, "the risks (of childhood vaccines) are trivial compared to the benefits," he says. "The vaccines don't cause death. It's the diseases that do that."