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The danger of refusing immunizations

By Stacy Beller Stryer, M.D.

Just last week three parents in my practice either refused or asked to alter the recommended vaccine schedule for their infants, and so far this week there have been another two. None of them have had good reasons, and none had truly researched the pros and cons of having their child receive each vaccine. The other day there was a memo on my desk, from the American Academy of Pediatrics, which discussed 5 children under age 3 years who had developed haemophilus influenza (Hib) in Minnesota last year, one of whom died. Three of the children who became ill, one of whom died, were unimmunized because of parent refusal.  Another had a recently diagnosed problem with the immune system, and the last hadn’t finished the Hib series at the time of illness.

It is difficult to hear these parents refuse the vaccine, and, although asked by parents, I cannot choose which vaccines they should get now and which they should get later because all are potentially deadly. If only parents could see what I saw as a medical student and resident, before there was the widespread use of the Hib vaccine, and before the development of the pneumococcus vaccine. If only they could see the infants and toddlers admitted with terrible infections, such as meningitis, where some developed permanent brain damage or total hearing loss, and others were not so lucky. Or the children who developed epiglottitis and could barely breathe, where even asking them to open their mouths or agitate them by examining them was risky and could cause respiratory collapse. Or those who developed arthritis in their hip or bones and received antibiotics for weeks, hoping that they would not need surgery or develop permanent damage. And, of course the many children who were admitted to the general ward or intensive care unit with pneumonia and significant respiratory distress. These are just some of the things I saw before the development of these two vaccines, most of which I just do not see anymore.

According to the Centers for Disease Control, before the widespread use of the vaccine about 15 years ago, Hib occurred in over 20,000 children per year, and about one in 200 children under age 5 years developed meningitis, with 25% of those affected developing permanent brain damage. Since the use of the vaccine, the number has dropped dramatically but is now beginning to increase again because parents are not immunizing their children adequately. The Hib vaccine prevents against infections such as meningitis, epiglottitis, septic joints, bone infections, soft tissue infections and pneumonia. There are no known serious side effects to this vaccine. The pneumococcal vaccine prevents against pneumonia, sinusitis, ear infections, meningitis, and soft tissue infections, among others.

Not only do parents harm their own children refusing a vaccine, but they also harm others. If parents don’t immunize their children, they are at greater risk of becoming ill with serious illnesses, are more likely to infect others with these infections, decrease the general “herd” immunity in the community, and may need to be excluded from school or other activities during outbreaks with vaccine-preventable illnesses. I am asking you to read about these vaccines, look at the research on their association with autism, ask your physician questions (we did spend seven years in medical school and residency learning about this), and make an informed decision. I am confident that, if you educate yourself, your decision will be the right one.

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One Response to “The danger of refusing immunizations”

  1. IndianCowboy says:

    I originally sent this comment to Dr. Val in an email with a link to a post I had written on this subject, but the more I read it the more I feel the need to comment more vocally.

    I am a fourth year medical student and eagerly awaiting the day when I take the oath and am able to call myself ‘Doctor’.

    But I am also a trained scientist, which is not part of our training as doctors. And ‘vaccine safety’ studies are fraught with methodologic and theoretical errors.

    There is absolutely no doubt that vaccinations have had a very positive effect on public and personal health. I unfortunately did have the experience of seeing a child with HIb epiglottitis last year, as well as a case of pertussis. Both were scary, and very sobering.

    But we actually have very little knowledge of how safe vaccines are or aren’t.

    Pre-marketing safety studies usually last just days, or at best a couple of weeks. How can you monitor for the possibility of vaccine-induced autoimmune disease if it takes 3-6 weeks to mount a full immune response in the first place? And may take even longer for autoimmune damage to show up?

    Post-marketing surveillance is notoriously poor, capturing, by the FDA’s own estimates, only 1-10% of all vaccine ADRs. And then, disingenuously, we use uncorrected figures from VAERS to show that certain diseases appear no more frequently than they do in unvaccinated populations.

    And there are hardly any retrospective case-control trials that have been done to exonerate vaccines have taken a comprehensive look, singling out diseases one by one, rather than casting a wider net, which would be necessary given the wide range of side effects that have been linked to certain disease (e.g. the case was made that HBV may be linked to neurologic sequelae ranging from peripheral to CNS deficitis–case-control studies ‘disproving’ this point focuses solely on MS)

    There is little doubt that a large component of the anti-vaccination movement is hysteria. But there is also little doubt that many of the claims of the more erudite among them are valid, and remain largely unaddressed.

    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. It has been beaten through the current generation of medical students’ heads that this is the era of ‘evidence-based medicine’. Let’s put our money where our mouth is and demand that we develop the evidence about vaccine safety in a convincing manner.

    It is not enough to speak from a position of authority. We must speak from a position of scientific integrity. Which we currently can’t.

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.


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