http://archpedi.ama-assn.org/issues/v154n10/ffull/plt1000-4.html
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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 studies10-12, 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.
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ALL
INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR
GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE
KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED
AS PROVIDING MEDICAL OR LEGAL ADVICE. THE DECISION WHETHER OR NOT TO
VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU
ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.