Universal Childhood Vaccinations: A Faustian Bargain?  
 

Although the article by Lee et al¹ is generally well balanced, the authors' portrayal of the childhood immunization issue is decidedly one-sided. Lee and colleagues state that "safety" and "failure to promote childhood immunization[s]" are major concerns in pediatric health care, yet they don't acknowledge the known risks associated with vaccinations, which may be responsible for many chiropractors' decision to educate parents about the benefits and possible adverse effects of vaccines rather than actively promote immunizations.

Vaccines have contributed greatly to the decreased burden of diphtheria, polio, and other infectious diseases, and without continued high vaccination-coverage rates, vaccine-preventable diseases are likely to become much more prevalent. However, mass childhood immunization programs are not without risk. While the authors focus on extremely rare complications resulting from spinal manipulation, they appear critical of the International Chiropractors Association's policy statement on vaccination, which "supports each individual's right to be made aware of the possible adverse effects of vaccines." Immediate adverse reactions associated with vaccinations, while rare, are more common than serious manipulation-related complications, and long-term adverse outcomes are biologically plausible and may be occurring given findings from recent epidemiologic studies.

Two committees convened by the Institute of Medicine concluded that there are causal relationships of measles-mumps-rubella (MMR) and diphtheria-tetanus-pertussis (DTP) vaccines with anaphylaxis.^{2, 3} The estimated rates of anaphylaxis range from 50 per million children for MMR to 60 per million children for 3 doses of DTP. The death rate from anaphylaxis is about 5%,⁴ thus for every million children given MMR or 3 doses of DTP, 2 to 3 children are expected to die. Furthermore, there is evidence that components of DTP vaccines have adjuvant effects,⁵ may cause a Th1 to Th2 shift in CD4 cells,⁶ and that exposure to allergens in early life may be critical to proper Th1-Th2 balance.^{7, 8} Of the 7 recent studies addressing the possible association of pertussis or DTP immunization with subsequent development of asthma or other allergies,^9-15 findings from 4 studies^{10-12, 15} are suggestive of an increased risk of allergic disease with immunization. Evidence from animal and human studies support the hypothesis that vaccinations may be 1 of many genetic and environmental factors contributing to the increasing prevalence of atopic disease in recent years.¹⁶

I could not agree more with the authors' call for "strengthening collaboration and research between the chiropractic, medical, and public health communities." Given our increasing reliance on mandatory vaccinations for infectious-disease prevention and the paucity of long-term safety data, we should work together to implement surveillance systems and design rigorous studies to generate the scientific data necessary for evidence-based decision making. If vaccine development is a Faustian bargain between life in the developed, overpopulated world and the natural world, let's have the courage to challenge and modify public-health policies and clinical practices while encouraging novel approaches for dealing with existing and emerging diseases.

 
Eric L. Hurwitz, DC, PhD
Department of Epidemiology
UCLA School of Public Health, Box 951772
Los Angeles, CA 90095-4047
 
 

1. Lee ACC, Li DH, Kemper KJ. Chiropractic care for children. Arch Pediatr Adolesc Med. 2000;154:401-407. ABSTRACT  |  FULL TEXT  |  PDF  |  MEDLINE

2. Howson CP, Howe CJ, Fineberg HV. Adverse Effects of Pertussis and Rubella Vaccines: A Report of the Committee to Review the Adverse Consequences of Pertussis and Rubella Vaccines. Washington, DC: National Academy Press; 1991.

3. Stratton KR, Howe CJ, Johnston RB. Adverse Events Associated With Childhood Vaccines: Evidence Bearing on Causality. Washington, DC: National Academy Press; 1994.

4. Yocum MW, Khan DA. Assessment of patients who have experienced anaphylaxis: a 3-year survey. Mayo Clin Proc. 1994;69:16-23. MEDLINE

5. Kosecka U, Berin MC, Perdue MH. Pertussis adjuvant prolongs intestinal hypersensitivity. Int Arch Allergy Immunol. 1999;119:205-211. MEDLINE

6. Mu HH, Sewell WA. Enhancement of interleukin-4 production by pertussis toxin. Infect Immun. 1993;61:2834-2840. MEDLINE

7. Prescott SL, Macaubas C, Yabuhara A, et al. Developing patterns of T cell memory to environmental allergens in the first two years of life. Int Arch Allergy Immunol. 1997;113:75-79. MEDLINE

8. Prescott SL, Macaubas C, Holt BJ, et al. Transplacental priming of the human immune system to environmental allergens: universal skewing of initial T-cell responses towards the Th-2 cytokine profile. J Immunol. 1998;160:4730-4737. MEDLINE

9. Nilsson L, Kjellman NI, Bjorksten B. A randomized controlled trial of the effect of pertussis vaccines on atopic disease. Arch Pediatr Adolesc Med. 1998;152:734-738. MEDLINE

10. Odent MR, Culpin EE, Kimmel T. Pertussis vaccination and asthma: is there a link? JAMA. 1994;272:592-593. MEDLINE

11. Kemp T, Pearce N, Fitzharris P, et al. Is infant immunization a risk factor for childhood asthma or allergy? Epidemiology. 1997;8:678-680. MEDLINE

12. Farooqi IS, Hopkin JM. Early childhood infection and atopic disorder. Thorax. 1998;53:927-932. MEDLINE

13. Nilsson L, Kjellman IM, Storsaeter J, Gustafsson L, Olin P. Lack of association between pertussis vaccination and symptoms of asthma and allergy [letter]. JAMA. 1996;275:760. MEDLINE

14. Henderson J, North K, Griffiths M, Harvey I, Golding J. Pertussis vaccination and wheezing illnesses in young children: prospective cohort study. BMJ. 1999;318:1173-1176. MEDLINE

15. Hurwitz EL, Morgenstern H. Effects of diphtheria-tetanus-pertussis or tetanus vaccination on allergies and allergy-related respiratory symptoms among children and adolescents in the United States. J Manipulative Physiol Ther. 2000;23:81-90. MEDLINE

16. Parronchi P, Brugnolo F, Sampognaro S, Maggi E. Genetic and environmental factors contributing to the onset of allergic disorders. Int Arch Allergy Immunol. 2000;121:2-9. MEDLINE
 

 
 

 

 
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