​You can’t turn on the TV, pick up a newspaper, or surf the internet without coming across the debate about childhood vaccines.
Most of these articles, posts, and testimonials make the vaccine question seem like it’s completely black or white: either you’re reading that vaccines are a miracle and of absolute necessity and you should do all the vaccines the CDC and your pediatrician recommend without question (and that you are “selfish,” and “dangerous” if you do not), or you are discovering websites and columnists who insist that vaccines are all dangerous, vaccines will kill your infant, and all vaccines are bad. These anti-vaccine sites insist that if you want your baby to be healthy, you shouldn’t do any vaccines at all.
Whether you’re a first-time parent or you have a gaggle of children already, you may be starting to wonder what to do about vaccines.
You’ve heard over and over that “vaccines are safe and effective,” but something—maybe your Mommy Instinct—is telling you to beware.
​According to a CDC-sponsored study [link to the word “study” published in the American Journal of Preventative Medicine, "Childhood Immunizations, First-Time Expectant Mothers’ Knowledge, Beliefs, Intentions, and Behaviors,” only 75 percent of new moms plan to do the vaccines according to the CDC schedule.
​The study also found that about 70 percent of new moms were not familiar with the recommended vaccination schedule and with the number of routinely recommended vaccines.
The study concludes: “Most who were planning to delay recommended vaccinations or were undecided relied primarily on socially available sources of vaccine information, rather than information provided by a healthcare professional. Improved access to vaccine information from healthcare professionals could foster better vaccine-related knowledge…”
I am a healthcare professional. I would like to foster better vaccine-related knowledge among expectant and new parents. I am also a pro-vaccine, pro-informed consent, pro-science pediatrician. I give vaccines in my office every day and I believe that vaccines are one important tool in the medical toolbox to prevent infections that can be dangerous and sometimes even fatal.
​I have also seen firsthand how vaccines can cause devastating side effects, both immediately after the injection or by damaging a baby’s long-term immune and neurological health.
As much as your doctor may downplay the risk of vaccines—and for most children the risk is small—vaccine injury is real. Some babies and small children can even die as a result of an allergic reaction to vaccines or from contamination in a hot lot of vaccines.
Questioning the timing, safety, and efficacy of some vaccines does not make you anti-vaccine, selfish, or dangerous. You are the parent. You have to live with the consequences of the health decisions you make for your baby. Not your doctor. Not the CDC.
The best thing you can do is to make considered vaccine decisions that are logical and make sense based on the medical needs of your family, the prevalence of vaccine-preventable diseases, and the risks, benefits, and efficacy of each vaccine. A top down, one-size-fits-all vaccination policy is not necessarily in the best interests of your baby’s health.
Here’s a secret you don’t see mentioned very often in the mainstream media: In my practice, it is often the best educated and most intelligent parents who question and alter the CDC schedule for their children. These are the moms and dads who read the scientific studies themselves, read the CDC’s website, and turn to other balanced and well referenced resources like the National Vaccine Information Center, Dr. Aviva Romm, M.D.’s website, Dr. Bob Sears, M.D.’s The Vaccine Book and Dr. Jennifer Margulis, Ph.D.’s Your Baby, Your Way.
I find it disappointing and a little baffling that so many pediatricians, OB-GYNs, and family doctors feel threatened by those well-educated and thoughtful parents who choose to delay or forego some vaccines on the current CDC schedule. Though your obstetrician or pediatrician may try to stick to the party line and push the entire schedule on you and your baby despite ample peer-reviewed evidence that this may not be the best choice, you can always say, “No, thank you. I need a little more time to consider. I do not want that vaccine at this time.”
Though I recommend parents follow the CDC schedule for some vaccines, pregnant moms should not get injections with aluminum (Tdap), which is a known neurotoxin that can cross the placenta and may harm your growing baby’s brain. Hepatitis B is a sexually transmitted disease. There is no compelling medical reason to give the hepatitis B vaccine to every newborn in America. Babies born to moms who do not have hepatitis B do not need this vaccine. You should wait until your children is a teenager and is thinking of becoming sexually active or is using intravenous drugs to get the hepatitis B vaccine series. There are numerous other recommendations I would make if I were your child's doctor. You can learn more at www.drpaul.md and www.drpaulapproved.com.
Educate yourself and your doctor on why you should never give your child Tylenol before or after a childhood vaccine
1. ​Factors associated with vaccination for hepatitis B, pertussis, seasonal and pandemic influenza among French general practitioners: A 2010 survey
“Our objectives were to describe the vaccine coverage (VC1) for some occupational vaccines (hepatitis B, pertussis, seasonal and pandemic influenza) among French General Practitioners (GPs2) and to study the factors associated with being vaccinated for each of these four diseases. We surveyed a representative national sample of 1431 self-employed GPs in France. Self-reported VC was 76.9% for 2009/10 seasonal influenza, 73.0% for hepatitis B, 63.9% for pertussis and 60.8% for A/H1N1 pandemic influenza. The factors associated with reporting being vaccinated were quite different from one vaccine to another. For some or all four vaccines, we found a significant positive association (p < 0.05) with the following factors in the multivariate analysis: GP’s male gender, high volume of activity, no particular mode of exercise (e.g. homoeopathy), no use of Internet at the practice, Continuing Medical Education sessions, discussing the benefits and risks of vaccination with the patients and performing prevention investigations for oneself (lipid profile). Being vaccinated for one vaccine also increased the VC for some or all three other studied vaccines. All these findings argue for public health campaigns using messages adapted to each vaccine.”
2. ​Influenza vaccination among healthcare workers in Italy The experience of a large tertiary acute-care teaching hospital
“Influenza vaccination is a fundamental tool for the prevention of influenza in healthcare settings and its administration to healthcare workers (HC Ws) is recommended in more than 40 countries including United States of America and many countries of the European Union. Despite these recommendations, the compliance of HCWs to influenza vaccination is largely inadequate in Italy. Since 2005/06 season, a comprehensive multifaceted intervention project aimed at increasing the seasonal influenza vaccination coverage rates among HCWs was performed at the IRCCS AOU San Martino IST teaching hospital in Genoa, Italy, the regional tertiary adult acute-care reference center with a 1300 bed capacity. Despite almost a decade of efforts, the vaccination coverage rates registered at our hospital steadily remain unsatisfactory and very distant by the minimum objective of 75% defined by the Italian Ministry of Health. During the last influenza season (2013/14), vaccination coverage rates by occupation type resulted 30% among physicians, 11% among nurses and 9% among other clinical personnel. Further efforts are necessary to prevent the transmission of influenza to patient and novel strategies need to be identified and implemented in order to increase the compliance of HCWs, particularly nurses, with the seasonal influenza vaccination”
3. ​Influenza vaccination in paediatric nurses: Cross-sectional study of coverage, refusal, and factors in acceptance
Influenza vaccination among health-care workers is poor, and the effectiveness of hospital vaccination programs remains unclear. Little is known about the effectiveness of intensive evidence-based vaccination programs in nursing staff. We determined whether the recommended vaccination rate could be achieved among paediatric nurses during an intensive promotional program for influenza vaccination. We also sought to identify the reasons for which nurses refuse the influenza vaccine and predictors of future vaccination intent.
We offered influenza vaccination to nursing staff during an influenza season through a multicomponent program that included intensive promotional activities. We analysed vaccination data to determine uptake rates. In a cross-sectional survey, self-administered questionnaires were distributed to all nurses with patient contact during that season. The questionnaire evaluated their vaccine use, site of work, absenteeism and physician visits due to respiratory illness, vaccination intent for the subsequent influenza season, and other items. We surveyed vaccinated nurses regarding their program experiences and the frequency and severity of adverse reactions. Unvaccinated nurses were asked their reasons for refusing vaccination. Multiple logistic-regression analysis was conducted to identify variables that predicted the likelihood of future vaccine acceptance.
More than 75% (895/1182) of applicable nurses were vaccinated in the program. The questionnaire response rate was nearly 48% (585/1230). Vaccination in the program during the current season (odds ratio [OR] 101.99, 95% confidence interval [CI] 52.54–197.98), program convenience (OR 199.19, 95% CI 98.01–404.11), and a physician visit for respiratory illness (OR 2.44, 95% CI 1.29–4.61) were found to be independent predictors of intent to receive the vaccine the following season. A lack of perceived personal need was the most common reason for vaccine refusal, given in 30% (77/258) of unvaccinated respondents.
Adequate coverage of nurses is achievable during an intensive voluntary immunisation program against influenza, using best-known practices. Perceived lack of personal benefit is a major deterrent, while program convenience and previous vaccination strongly predict future vaccine acceptance. Our findings support interventions that improve the convenience of hospital immunisation programs for influenza, particularly those that are aimed at nurses and that promote vaccine efficacy and benefits.”
“The study evaluates knowledge, attitudes, and behavior of mothers regarding the immunization of 841 infants who attended public kindergarten in Cassino and Crotone, Italy. Overall, 57.8% of mothers were aware about all four mandatory vaccinations for infants (poliomyelitis, tetanus, diphtheria, hepatitis B). The results of a multiple logistic regression analysis showed that this knowledge was significantly greater among mothers with a higher education level and among those who were older at the time of the child's birth. Respondents' attitudes towards the utility of vaccinations for preventing infectious diseases were very favourable. Almost all children (94.4%) were vaccinated with all three doses of diphtheria-tetanus (DT), oral poliovirus vaccine (OPV), and hepatitis B. The proportion of children vaccinated who received all three doses of OPV, DT or diphtheria-tetanus-pertussis (DTP), and hepatitis B vaccines within 1 month of becoming age-eligible ranged from 56.6% for the third dose of hepatitis B to 95.7% for the first dose of OPV. Results of the regression analysis performed on the responses of mothers who had adhered to the schedule for all mandatory vaccinations indicated that birth order significantly predicted vaccination nonadherence, since children who had at least one older sibling in the household were significantly less likely to be age-appropriately vaccinated. The coverage for the optional vaccines was only 22.5% and 31% for measles-mumps-rubella and for all three doses against pertussis, respectively. Education programmes promoting paediatric immunization, accessibility, and follow-up should be targeted to the entire population.”
“Angelillo IF, Ricciardi G, Rossi P, Pantisano P, Langiano E, Pavia M. Mothers and vaccination: knowledge, attitudes, and behaviour in Italy. Bulletin of the World Health Organization. 1999;77(3):224-229.”
“In response to the 2009 H1N1 influenza pandemic, health care workers (HCWs) were offered immunization with H1N1 vaccine in addition to seasonal flu vaccine. Previously, low rates of influenza vaccine uptake in HCWs have been attributed to concerns about vaccine clinical effectiveness, side effects and access difficulties.
To explore H1N1 influenza vaccination of HCWs in London during 2009-10 and examine reasons for vaccine refusal.
An online questionnaire survey of doctors and nurses working in two primary care trust (PCT) areas and one acute trust area was carried out in London.
Only 59% of the 221 respondents had been immunized with H1N1 influenza vaccine and 43% with seasonal influenza vaccine. The commonest reasons for remaining unvaccinated were 'side effects', 'swine flu not severe' and 'concerns about clinical effectiveness of the vaccine'. Respondents who had been vaccinated that season gave positive feedback on their experience.
While uptake among HCWs was greater for the pandemic vaccine than is usually seen with seasonal influenza vaccine, this survey suggests that in this area of London during the 2009 pandemic, HCWs refused H1N1 vaccination due to concerns about clinical effectiveness, side effects and perceptions that H1N1 infection was not generally severe. We found no evidence to suggest poor access was a barrier to H1N1 vaccination of HCWs. If good access is maintained, the key barrier to improving seasonal flu vaccine uptake lies with informing the personal risk assessment made by the HCW.“
“The purpose of this study was to identify vaccination patterns of both general pediatricians and subspecialists with regards to their own children and projected progeny. A 14 question survey was sent randomly to 1000 members of the Academy of Pediatrics in 2009. Two categories of questions included 1) how physicians with children vaccinated them in the past, and 2) how all respondents would vaccinate a child in 2009. A comparison was made between the answers of general and specialty pediatricians. 582 valid questionnaires were received (58.2% response rate) of which 431 were general pediatricians and 151 subspecialists. No statistical difference was found between general and specialty pediatricians on how they vaccinated their children up until 2009 (95% vs 93%). When asked about vaccinating a future child, a significant proportion of respondents would deviate from CDC guidelines, specialists more than general pediatricians (21% vs 9%). Generalists were more likely to give a future child Hepatitis A (OR: 3.6; 95% CI 1.3 - 10.4), Rotavirus (OR: 2.2; 95% CI 1.1 - 4.4), Meningococcal (OR: 9.9; 95% CI 3.3 - 29.9), and influenza (OR: 5.4; 95% CI 1.1 - 26.7) vaccines. Specialists were more likely to postpone MMR vaccinetion (OR: 4.4 95% CI 2.3 - 8.6). Safety was listed by both groups as the most common reason for altering the recommended immunization schedule. Until 2009, general pediatricians and pediatric specialists have largely adhered to ACIP recommendations, but due to vaccine safety and other concerns, both groups, albeit a higher percentage of specialists, reported greater numbers willing to diverge from these recommendations.”
It is very fitting that November is Diabetes Awareness Month, since it deals with a subject that is currently affecting almost 100 million Americans. In my new book, "The Diabetes Solution," I decided to tackle this important issue, not only because of how many Americans are affected but because in the United States over 200,000 people die unnecessarily from complications of diabetes every year.
I think it makes more sense to follow the dietary guidelines of the Joslin Diabetes Research Center at Harvard Medical School. They are remarkably similar to the Zone Diet.
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