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Parents need to know about vaccine safety

By Stacy Beller Stryer, M.D.

After my blog last week discussing the recent increase in Haemophilus influenzae B (Hib) cases in Minnesota, I received a comment from “Indian Cowboy,” who is a blogger and fourth year medical student. While Indian Cowboy admits that he isn’t completely against vaccines, he does question their safety and says that, “if my (future) patients were to ask me specifically, scientifically, what the risks of vaccines are, I would be forced to shrug my shoulders and say I actually have no idea.” He suggests that pediatricians, in general, are not open and honest with their patients about any side-effects associated with vaccines. Furthermore, Indian Cowboy comments that he is a member of the “current generation of medical students,” where evidence-based medicine is important. Does this mean that we old-timers (yes, I am an ancient 45 years old), don’t practice medicine based on results of quality studies and proof of what actually works?

 

That is far from the truth. My colleagues and I practice medicine based on what has been proven to work and not just what we learned on a whim. We continue to read reputable journal articles and other medical literature, often discussing treatment changes based on new research. And I do not know any pediatrician who makes a blanket statement that vaccines are 100% safe. Personally, I spend a fair bit of time talking to parents who question vaccine safety. I tell them that anybody can have a reaction to a vaccine, just like anybody can react to an antibiotic, food, or something in the environment. I also discuss more common side effects of vaccines, such as fever, redness, and irritation at the injection site. In addition, I mention that there are very rare, more serious side effects associated with some vaccines, such as seizures and encephalitis. I am certainly not the only honest pediatrician in the United States. In fact, reputable organizations such as the Centers for Disease Control (CDC), which are major advocates for vaccines, clearly state on their website that no vaccine is 100% safe or effective.

 

Just as importantly, and an absolute necessity is discussing that the risk of becoming seriously ill or dying secondary to a vaccine is much lower than the risk of developing a serious illness or dying if a child becomes ill with one of the infections for which they could have been vaccinated. Parents must be aware of the benefits of receiving these vaccines. And they should know that vaccines are one of the greatest medical discoveries of the 20th century and have increased life expectancy and quality of life significantly.

 

Back to Indian Cowboy – he also comments that we really don’t know much about vaccine safety because studies only last days or, at most, a couple of weeks. This is also far from the truth. Before a vaccine is licensed, the Federal Drug Administration (FDA) requires testing. Once the vaccine is being used, the CDC and FDA look for any problems and investigate them through the Vaccine Adverse Event Reporting System. It’s true that this system depends on pediatricians and parents to report side effects. This was recognized as a problem, so in 1986 a National Childhood Vaccine Injury Act was developed which, among other things, required experts to intensively review any possible adverse effects of vaccines. In 1990 the Vaccine Safety Datalink project was developed, where researchers gained access to the medical records of over 5.5 million people to evaluate for common and rare side effects associated with vaccines. All of these different safety methods have led to changes in vaccines to make them safer. In 2000, children began to receive the inactive polio instead of the live polio vaccine due to the rare risk of developing polio from the oral vaccine. More recently, the pertussis vaccine was changed from a whole cell to an acellular one because of the increased risk of rare neurological side effects.

 

I could continue, but the bottom line is that immunizations have been tested extensively for safety and continue to be monitored by reputable, quality organizations. There is an abundance of information available on safety for every vaccine. It is true that we cannot assure parents that their child will not develop a severe allergic reaction or a rare side effect to a vaccine. And we cannot say that we are 100% sure that vaccines do not affect the brain or the immune system, such as we cannot assure them that they will not get into an accident when they step into a car or that they will not be hit by a car when they cross a street. But we can reassure them that the chances of such an event are rare and that the benefit of receiving the vaccine far outweighs the risk of not receiving it.

 

I certainly hope that the one case of epiglottitis and pertussis that Indian Cowboy saw last year makes him realize not only how serious these infections can be in infants and children, but also that he only saw one case of each whereas, without immunizations, he would have seen many more and, most likely, a few deaths.

 


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6 Responses to “Parents need to know about vaccine safety”

  1. IndianCowboy says:

    Dr. Stryer,

    Thanks for responding to my comment. I appreciate the fact that you took the time to do so.

    That said, I feel that justice wasn’t done to the concerns I raised, particularly the short length of pre-licensure trials (the safety arms of which, do in fact only last 5-14 days according to the primary literature), the failure to use a proper placebo (an immunologically and inflammatorily reactive aluminum adjuvant is not a placebo), the low capture rate of VAERS and VSD, or the fact that contrary to common assertion, potential causal relationships between certain vaccines (and aluminum within vaccines) and neurologic and autoimmune disease have been voiced at a theoretical level, demonstrated in animal models and human case reports, histopathology, and serology, and defended in challenge-rechallenge studies.

    A more complete response can be found here.

    Again, I think we both have the best interests of our patients in mind. But I think that the potential evidence of harm, while not great enough to remove certain vaccines from the market, is more than enough to take a more cautious stance on their use and safety, and to investigate possible sources of toxicity. This becomes more important as we vaccinate for less prevalent and more individually-preventable diseases with lower overall morbidity and mortality.

  2. Edwin Leap says:

    Val,

    Indian Cowboy seems to believe that we are now in an era of ‘science’ whereas the last was an era of mystery and magic.

    The term ‘evidence-based medicine’ is a much abused term, and I’m finding that it often serves as a kind of dismissive term. ‘Oh, I don’t know about that…I believe in evidence-based medicine.’ Well, the truth is that EBM is valuable, but only truly valuable if we all read the methods of every study; and understand them. Without that, we practice what is, in effect, authority-based medicine. That is, someone we respect tells us it’s the right thing to do because it looked like a good study. I’m OK with that. I trust some certain docs to make that interpretation.

    But more than that, much of what we do and know was never based on studies but on experience. Tacit truth is real, and experiential medicine has carried us far along the path toward life-saving interventions. We may be 4th decade Neanderthals, but we’re darn good at what we do.

    Ask Indian Cowboy if he’s ever tried to intubate a swollen airway. I have. It’s profoundly icky and anxiety provoking. For that reason alone, let’s keep immunizing for H. Influenzae B.

    Thanks,

    Edwin

  3. albatross says:

    As another datapoint: Our pediatricians’ office has handouts explaining the potential problems with the vaccines our kids get, and those discuss the low-probability really bad stuff. But the only warnings I have gotten from the doctors and nurses themselves have been for mild stuff (“his arm may be sore for a day or two; give him ibuprofin if it’s a problem”), never for the low-probability scary stuff like encephalitis. I assume if I had asked about the scary risks, they’d have discussed them with me, but I’ve never tried it.

  4. IndianCowboy says:

    Dr. Leap,

    I’d appreciate it if you actually read the comments in question. You’re free to read what I wrote myself in my blog and address it. When I used the term ‘evidence-based medicine’ I was in fact making fun of the fact that its become a buzzword more than anything else.

    I never implied that older doctors don’t practice intelligent medicine. And I don’t much appreciate words being put in my mouth (or my fingers as the case may be).

    But authority-based practice is antithetical to science. I realize medicine isn’t itself a science, but I think everyone can agree that it is a science-based pursuit, just as engineering is. Remember, knowledge is gained not by asserting what we believe to be true, but exposing the areas of our ignorance and studying them.

    I find it disheartening that my concerns are blown off and instead doctors who I respect and whose blogs I read on a regular basis resort to name-calling and rhetoric.

    You’re right, I’ve never had to intubate a swollen and inflamed airway. I have on the other hand lived with the consequences of a vaccine injury for the past 11 years. Now, if you’ll excuse me I have to pick up x-rays for a surgical consult regarding one of the sequelae of that vaccine injury, and then hit the gym for rehabilitation.

  5. Stacy Beller Stryer says:

    I hear what you are saying. And I agree that we do not know everything about vaccines and their potential side effects. However, these side effects you discuss are rare, whereas the infections are not. For instance, the likelihood of developing enephalitis after a DPaT shot is less than 1 in a million. The number of children who would develop one of these infections without a vaccine is much, much greater, as is the risk that they would suffer permanent sequelae or die. You also mention concern regarding vaccines for less common infections, such as cervical cancer. The likelihood that a woman will develop cervical cancer is 1 in 10,000.

    I understand that you have blogged about a neurologic problem reportedly due to a vaccine, and I am truly sorry for that. Yet, you are alive and in medical school – you have survived and done well. My husband passed away from a glioblastoma, which occurs slightly more frequently than cervical cancer. If I were told there was a vaccine to prevent a glioblastoma, my family would be the first to stand in line.

    Millions of children have been vaccinated. It is obvious that severe side effects are not common. Children must continue to receive their vaccines in a timely manner while researchers must continue to monitor side effects and perform quality research.

    Stacy Beller Stryer

  6. Stacy says:

    Thank you so much for blogging about vaccine safety. The anti vax camp is so much more vocal than the pro vax camp and this needs to change.

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