Doctors debate 'delayed vaccine' schedule

December 29, 2008

Dr. William Schaffner is no stranger to parents' fears over vaccines. But at a talk next month at his grandchildren's school, to a room packed with parents, Schaffner said his job will be less about convincing parents that their kids need vaccines -- and more about convincing them that they need to adhere to the recommended schedule.

"I've already heard there's going to be an overflow crowd at my talk," said Schaffner, professor of infectious diseases and chairman of the department of preventive medicine at the Vanderbilt University School of Medicine.

Indeed, fears among some parents that the current regimen of infant vaccinations involves too many vaccines too soon have reinvigorated the debate over childhood vaccine safety.

In October 2007, Dr. Robert Sears, a pediatrician in Capistrano Beach, Calif., published "The Vaccine Book: Making the Right Decision for Your Child." Included in Sears' book, which sold more than 40,000 copies, was an alternative vaccine schedule that would allow parents to delay -- and in some cases completely avoid -- many vaccines for their children.

On Monday, the American Academy of Pediatrics (AAP) is issuing its updated childhood vaccination schedule, along with an article that deconstructs Sears' popular "delayed vaccine" schedule.

In accordance with recommendations from the U.S. Centers for Disease Control and Prevention, the new AAP vaccination guidelines include a recommended flu shot for all children 6 months of age and older, as well as a two-dose schedule for the rotavirus vaccine.

But more importantly, the article released alongside the guidelines outlines the safety and efficacy issues associated with following an alternative vaccine schedule, such as that proposed by Sears.

Dr. Paul Offit, lead author of the report and chief of infectious diseases at The Children's Hospital of Philadelphia, wrote in his article that "at the heart of the problem with Sears' schedules is the fact that, at the very least, they will increase the time during which children are susceptible to vaccine-preventable diseases."

And according to infectious disease experts, the longer a vaccine is delayed for a child, the longer the child is at risk for contracting a potentially preventable and debilitating disease.

"Sears' proposed schedules ... are really not ideal for protecting that baby," Schaffner said. "This alternative schedule may respond to parental anxiety at the price of keeping the baby susceptible to serious infectious diseases for a longer period of time."

According to Schaffner, many parents' anxiety over vaccine safety and eagerness to find an alternative vaccine schedule for their children has increased exponentially.

"There's been an awful lot of anxiety expressed in the media about vaccines and allegations about vaccines," Schaffner said. "And most importantly, as the diseases that vaccines prevent have disappeared, our young parents have no personal experience of these diseases and neither do their parents."

Additionally, Offit remarks in his report that the vaccine schedule proposed by Sears was not tested for safety and efficacy in any clinical trials, and is not backed up by the same body of evidence as the CDC's recommended vaccine schedule.

Dr. Peter Hotez, professor and chairman of the department of microbiology and tropical medicine at The George Washington University, said recommending alternative vaccine guidelines to the public without any scientific evidence to support the safety and efficacy of such recommendations "makes no sense."

"Altering the schedule without the support of clinical trial data creates a severe risk for inadequate vaccine," Hotez said. "So, any delayed schedule risks creating a vaccine schedule that won't give you as much of a robust immune response as the recommended schedule."

"I will follow the new CDC recommendations for my children," he added.

But Sears said he believes many vaccine experts are misinterpreting his work as "anti-vaccine," while his intent in offering an alternative vaccine schedule was to show parents who might not otherwise vaccinate their children at all that they can immunize their children in ways with which they may feel more comfortable.

"While Dr. Offit and I share the same opinion on the importance of vaccines, at the end of the day we will have to continue to agree to disagree on one major point: He believes that offering parents the option of an alternative vaccine schedule that spreads out the shots and allows worried parents to vaccinate their babies in a manner they are more comfortable with, will result in lower vaccination rates because it legitimizes these parents' fears about vaccines," Sears said. "I, on the other hand, believe that providing parents who otherwise would not vaccinate at all with a schedule of vaccines that they feel right about for their baby, will encourage such parents to vaccinate."

Dr. Samuel Katz, professor and chair of the department of pediatrics at the Duke University Medical Center, said that Sear's proposed schedule should only be used as an absolute last resort for parents who refuse to vaccinate their child otherwise.

"This might rarely be an exceptional alternative as a last resort, choosing to administer as soon as possible those vaccines for which the infections remain prevalent in the U.S. with most serious morbidity and mortality ... and spacing out [the rest]," said Katz.

However, many vaccine experts maintain that the potential benefits of this alternative vaccine schedule do not outweigh the drawbacks.

Schaffner said that if parents are concerned about the safety of vaccines and the recommended vaccine schedule for their children, the best thing they can do to quell those fears is to educate themselves.

"The way I see it, Dr. Sears has created a solution to a problem that doesn't exist," Schaffner said. "The problem isn't with vaccine safety, because they've been exonerated from all the implications of autism and all the other illnesses associated with vaccines.

"So, the true solution would be confidence in [your] doctor's position and to try to get as much information as possible, and to allow that information to trump your anxiety."

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