Public health officials fear parental suspicion of vaccinations
August 27, 2008
By Deborah L. Shelton and Deanese Williams-Harris
Aug. 28, 2008 (McClatchy-Tribune News Service delivered by Newstex) -- CHICAGO -- Angela O'Connell will not allow her 15-month-old son to be vaccinated against measles, mumps and rubella because she is certain the vaccination caused autism in her older boy, Aidan.
"The little boy that would stare into your eyes and laugh when you played with him turned into a boy that wouldn't even respond when you called his name," the Minooka mother said.
Over and over, careful scientific research has found no link between vaccinations and autism. Experts note that autism tends to emerge at the same age kids receive their shots, leading to a false sense of cause and effect.
But stories like O'Connell's are so powerful, and so easily spread online, that pediatricians say they are spending unprecedented time answering questions about vaccinations, from mercury fears to concerns over the increasingly intense schedule of shots.
Parental suspicion is now so high that public health officials fear it could undermine one of the most important advances in medical history. Although vaccination rates have remained fairly steady, pockets of vaccine rejection can lead to outbreaks of childhood diseases that were once thought conquered.
Last week federal officials reported that measles cases in the U.S. have reached their highest level in more than a decade, with nearly half of the cases involving children of parents who opted against vaccination.
Doctors say worried parents tend to find scientific data less persuasive than the horror stories they hear about vaccine side-effects online or from friends. One expert said attitudes are likely to change eventually, but only after children start dying again of diseases parents have come to think of as obsolete.
"I think people have a hard time separating out what's reliable information and what's not reliable," Dr. Ruben J. Rucoba, a Wheaton, Ill., pediatrician. "What gets attention is not the statistics, but the story. All it takes is one friend of a cousin of a neighbor who they can point to who says, 'My child got an immunization and now he has a problem.' "
Rucoba and other pediatricians say they are frustrated and worried about how to reassure parents.
"The number of people who are trying to make changes in the vaccination schedule based on what they have heard or seen or read on the Internet is climbing every year," Rucoba said. "Even those who ultimately decide not to alter the schedule have questions about it, and every year we spend more time talking about immunizations with parents."
In the next few weeks the Illinois chapter of the American Academy of Pediatrics will launch a survey to ask pediatricians how much time they spend answering parents' questions, how it affects their medical practice and whether they are asking parents who refuse shots to leave their practices.
One of doctors' biggest concerns is loss of "herd immunity." Because no vaccine is 100 percent effective, successfully fighting disease requires that most children be vaccinated. Some communities may already have reached a tipping point, said Dr. Paul Offit, chief of infectious diseases at the Children's Hospital of Philadelphia.
Immunization rates overall remain high, but experts said clusters of unvaccinated children are cause for alarm. Dr. Jane Seward, deputy director of the CDC's viral diseases division, said the measles outbreaks this year had hit areas with "pockets of susceptible people."
In Illinois, at least 25 of the state's 32 cases were home-schooled children whose parents did not vaccinate them for religious reasons, according to the CDC. Illinois parents also can apply to school districts for a medical or religious exemption, with medical exemptions granted only to children with a history of severe reactions to vaccines and those whose immune systems are fragile, such as cancer patients.
Dr. Rashmi Chugh, medical officer at DuPage County Health Department, stressed that unvaccinated people who come down with measles can transmit it to medically vulnerable children who are unable to get the shots.
"It is important for people to protect themselves as well as others who come in contact with them," she said. "As long as there are pockets in the community that remain unvaccinated, that certainly increases the risk of ongoing transmission of measles in the community."
No one has died in the seven outbreaks seen in the U.S. as of July 30, but more than a dozen patients have been hospitalized, according to the CDC. Measles is one of the first diseases to reappear when vaccination coverage rates fall, the agency said.
Doctors say the most common questions from parents concern the idea that autism may be linked to a mercury-based preservative called thimerosal that used to be a frequent ingredient in vaccines. The preservative has been removed from most childhood shots, and recent research has found no link between thimerosal and autism.
"My heart aches for the parents of an autistic child," said Dr. Kenneth Alexander, chief of pediatric infectious disease at the University of Chicago. "Nonetheless, to accuse vaccines of causing autism is a misplacement of blame; people who claim that vaccines cause autism are executing the wrong suspect for the crime. I don't know what causes autism, but study after study show that it is not immunization."
Erin Micklo, of Glen Ellyn, Ill., is one parent who believes the measles, mumps and rubella shot had a negative effect on her son, Emmitt. Within a couple of days of being vaccinated, the 18-month-old boy developed a high fever and a rash and became extremely lethargic, she said. He was later diagnosed with autism.
"The childhood vaccination schedule shouldn't be a one-size-fits-all because every child is different," said Micklo, who has decided against having him vaccinated again.
Offit said the heavy vaccine schedule puts off many parents. Children get 14 vaccines by 2 years of age, with as many as 26 inoculations in total and five shots at one time, he said.
Amanda Covington, 36, a visitor to Chicago from Georgia, said she watched last week's reports about measles on TV in her hotel. She said deciding about vaccination is confusing but she has opted for the shots.
"Every day you hear that something is unsafe for children," she said as she left the Nordstrom store on North Michigan Avenue with her two daughters, ages 3 and 7 months. "I feel the risk of my children getting sick outweighs the risk of them developing a more serious disease from vaccinations. As a parent, you have to put your trust in the doctors."
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