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Vaccination Guest Post: Is there value in delaying?


(This is the third post in a series of guest posts by Dr. Mark McColl on vaccinations.  We don’t have to agree on this topic to still be sisters and friends.  I’m providing these posts as a source of information for those who are still doing research, not those who have their minds made up.  Please read my vaccine history and the introduction of Dr. McColl before proceeding with Posts 1 and 2 and then reading this one.)
What is the benefit of combining vaccines and is there wisdom in separating them out over time?
What are the risks of a delayed vaccination schedule?
It seems like part of our nature to try and make sense of drastically different viewpoints by compromising to a middle ground.  Somehow we believe that moderation is a better option than either extreme.  Right wing and left wing politicians need to come together somewhere in the middle to get things done.  Low fat versus low sugar diets are at odds with each other.  Isn’t it best just to eat ‘everything in moderation’?  This flawed logic argument is called the golden mean fallacy.  Either extreme makes us feel like we are drawing a line in the sand and choosing sides when really we just want everyone to get along.
In the vaccine debate there are those who say we should fully vaccinate our children on schedule and those opposed who believe that all vaccines are toxins to the body and should be avoided.  Many have taken the golden mean and proposed a slower schedule in an attempt to compromise.  But should we compromise?  Do we think compromise is good for other aspects of our children’s health and safety?
We believe our children shouldn’t have any arsenic in their school lunches.  We believe the bus driver shouldn’t have any alcohol in their system on the way to school.  We think the first ride in the car home from the birthing center needs to be in a five point harness of a car seat.  So in the debate on schedules we should look at it from what is a good idea for our children and not trying to find a compromise between two stated opposing viewpoints.
I believe that the soonest we can protect our children from a preventable fatality or injury we should.  That really is the basic idea behind the national and international guidelines for vaccinations.  The general thinking is why wait to do anything that can protect our children when it can safely be done now.  Some vaccines prevent against diseases which typically only affect certain age groups.  For instance Streptococcus pneumoniae and Haemophilus influenzae type b which both cause serious brain and blood stream infections most commonly occur in children under the age of five.  About 90% of these infections occur in children less than 2 years of age.  So it is advisable to receive these vaccinations as young as it is medically appropriate.
Other vaccinations such as Hepatitis B have a different risk profile.  Historically, the greatest risk of an infant contracting Hepatitis B was at delivery.  For many years, prenatal care was sparse and routine testing for Hepatitis B was not done.  In some places women only present to their local health care provider at the time of delivery.  In these cases, if the mother does have Hepatitis B there are a few things that can be done to help cure the child.  One of which is to give the Hepatitis B vaccine.  With that initiative over the years the safety of vaccinating newborns was well established and that has become the standard of care in many communities.  Altering that schedule for children born to women known not to have Hepatitis B and not exposed to Hepatitis B in their household is often proposed.  The question revolves around deciding at what age do we believe the child begins to have risk and do we believe we can fully know when and how the risk will occur.  If we decide to wait one month, two months, or two years to vaccinate against Hepatitis B how much are we increasing the risk of that child acquiring the disease?
That question is hard to answer because we can’t predict the future.  In my own practice, 100% of the newborns I care for in the hospital nursery have been born to a mother who knows her Hepatitis B status.  Infants born to mothers who do not have Hepatitis B and do not have an expected exposure in the first two months of life are offered a delayed vaccination.  Hepatitis B comes in a combination shot that I stock in my office.  I can use this combo shot, administer Hepatitis B with the other scheduled vaccines at two months of age, and reduce needle sticks the child will receive in order to be fully vaccinated.  I believe the very low risk of acquiring Hepatitis B if a child has no perceived exposures is worth reducing the number of times they need to be poked with a needle.  That’s a very fine line to walk.  I wouldn’t feel comfortable waiting two years to vaccinate for Hepatitis B.  Additionally, if the parents were planning foreign travel or had a household member with active Hepatitis B I would recommend the vaccination at birth.  So you can see that even in an infection that is relatively hard to transmit it is difficult to justify a delayed schedule because there are still so many unknowns.
As this thinking of timing of risks and possibility of delay works its way through the other vaccines, I’ve had several families approach me with various ideas for a delayed schedule.  Although there is no documented benefit of a delayed schedule and no documented risk of vaccinating along the national guidelines, families still sometimes propose this approach.  The most commonly proposed alternate schedule comes from a popular book on vaccinations published a few years ago.  I have serious concerns as to the motivation behind this different schedule.  It increases the number of office visits needed for check ups and vaccinations substantially.  In the author’s own private practice he does not accept medical insurance and requires fee for service payment directly from the patient’s family.  So families attempting to follow his recommendations for a delayed schedule have approximately 2-3 times the number of visits to his office than the standard check up schedule.  The cost of the vaccines comes out of pocket as well.  I can’t help but wonder if there isn’t a financial motivation behind all this given there is no published scientific evidence for its benefit.
From a practical standpoint I know delayed schedules don’t work in my office.  Procrastination rarely does.  Early in my practice I had several very winsome and gracious mothers convince me to try a delayed vaccination schedule with their children.  We worked the program diligently.  I even printed out the agreed upon delayed schedule and kept it handy for all their visits.  It became clear early on that these children were always behind on their vaccinations even by the delayed schedule standard.  In the end when kindergarten was just around the corner we had a lot of catching up to do.
I kept feeling as though we were not protecting these children as well as we could.  I would catch myself holding my breath hoping nothing was going to happen to them as we waited another month to do the next vaccination.  After those experiences I’ve declined to enter into further delayed schedules.  I know I can’t adequately take care of these children that way.
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  1. We have a good friend who is a chiropractor. I understand that in general chiropractors and physicians usually have a different viewpoint on their approach to medication. Our friend has explained that the reason a delayed approach to vaccinations is better is because the nervous system has had time to develop, meaning 1. the chances of vaccine injury are lessened, and 2. the vaccine is more effective in this better developed nervous system. He has medical journals to back up this theory. I know this is the reasoning behind many parents choosing to delay vaccination. I wonder what Dr. McColl would say in response to this. I was disappointed that he did not address this aspect of the delayed vaccination idea and just made it seem like parents were choosing less of a good thing simply for the merit of choosing the middle ground.

    • Melodie, that’s a common argument made for delaying vaccinations but the burden of proof is on those that want to delay. Two things that need to proven. First, it is true we are not born fully mature in our nervous system, but there isn’t fundamental difference between a newborn and an 18 year old (chosen because we peak in our ability to harness the nervous system-muscle interaction at about this age). We don’t grow into something else with new nerves. We don’t change how those nerves interact or work either. We simply improve the efficiency of the process. So the question that must be answered is does the maturation of the nervous system change the way vaccinations are processed in the body? The second hurdle that has to be addressed with a delayed schedule is what about all the diseases that don’t wait for your nervous system to mature before they destroy it. Many diseases only affect the young. If we wait on providing protection then we really don’t end up protecting them all that much.

      You are absolutely right to point towards medical journals to support your theories. The wealth of journal articles supporting our general vaccination protocols is available at places like http://www.chop.edu/service/vaccine-education-center/home.html.

      Would you be able to provide the journal references your chiropractor friend cites? The wonderful thing about medicine is how very democratic it is. Anyone with good evidence gets a voice in the discussion and there is always more information we all need to learn.

      • Thanks for your response. I am not sure that our friend has the articles easily available right now. They just moved and he is very busy getting established with their new home and practice. But if I am able to find out I will be sure to come back here to share the source.

        I attended an informational session on vaccines at a local chiropractic center and they were obviously biased against all vaccinations. What I like about our friend as that he is not anti-vacination, just wants to be cautious based on what he has learned. That and he believes regular adjustments cure everything :-).

  2. I am really enjoying these articles. We have decided to vaccinate, but I love that he builds trust with his patients and is open to questions and disagreement. I feel we have a similar relationship with our pediatrician, and I really don’t know how you can go through childhood difficulties without a dr or someone you trust for medical advise.

  3. I’m somewhat behind the times, having recently come across these articles. My sentiments are similar to Melodie’s (I also did not find the assumption that those who are trying, even if incorrectly by Dr McColl’s assessment, to do best for their children, are in fact just trying to make everyone get along. This is not accusatory, I think that others were simply overlooked, but I thought I’d give feedback on how it looked when you read it as someone who thinks that waiting could be BETTER for their child)

    Anyway. My question was sort of similar, also I was thinking it would be beneficial for the IMMUNE system to be able to get stronger before being given vaccines and immunizations. Is this misinformed? I have seen, though not given credence to or looked into further, the idea also that vaccines and immunizations, far from being a burden on an immature immune system, can sort of slip under it’s radar and not have the immune-building effect they’re desired to produce. Is there truth in either of these ideas? I hadn’t heard about nervous system-based objections, but I would imagine that the immune system of a two-year-old or three-year-old would be far more developed and robust than that of an infant?

    Also, where is the line in which are needed? It sounds like Dr McColl is for all possible vaccines. My line of thinking isn’t so much “could it maybe, potentially be helpful? If so, it’s unquestionably worth it.” as “are there risk factors associated with these vaccines? Does the risk of my children contracting x bacteria/virus outweigh?”

    And in the case of HPV it’s an issue of what moral message I may be sending, though at the moment purely hypothetical, as we only have boys thusfar! I assume, based on what’s been written, that Dr McColl might acknowledge the same sexual morality as I hold to be true, so I am curious whether this came up during the decision process and how it was decided not to be a cause for concern. Was it simply a matter of just-in-case?

    To be clear, I am not trying to be confrontational, so if it seems so, my apologies in advance, and just know that it was certainly not purposeful!

    Maria :]

    • I also did not find the assumption that those trying to best by their children, even if mistaken, are merely compromising a very understanding assessment*

      Bah, got lost in my commas! I just meant to say it’s discouraging to read that it appears as though we (as someone who has gone a delayed route while searching for truly reliable information so as not to harm our children unintentionally) are simply seeking peace as the cost of a child’s health. I find, for example, B.A.C. of a bus driver non-analogous. Just wanted to point that out, as it seemed to have been overlooked.

    • Maria,
      Maralee asked if I would comment on your thoughts. I appreciate you leaving more feedback on a long quiet thread.

      On the topic of the immaturity of the immune system, I think people are generally misinformed on the status of our immune system. “Immune booster” supplements are all the rage but are virtually worthless. It’s like saying a lion needs a boost to protect himself from an ant. Over the course of life our immune system wins every single fight save one and that defeat doesn’t come until late in life for most of us.

      Additionally, diseases that kill children don’t wait until they get older to attack. If we wait our children die. Here in the Appalachian mountains there are lots of homestead sites and they all have graveyards near by. Looking at all the infants buried there is a reminder that until about 1950 infections were the most common cause of death for all humans.

      HPV vaccination is a difficult topic for many people. I think the point most don’t understand is that the person making the decision on whether a woman develops cervical cancer is not the woman but rather the man with whom she has relations. Its his decision to be morally pure that matters more than her decision. I am teaching my daughter to be chaste and abstinent till marriage but in the end it’s not her decision to develop cervical cancer. By analogy, we wear our seatbelts sometimes to protect against our own bad decisions but also to protect us against someone else’s bad decision.

      Thanks again for the feedback.

  4. Thanks for that! I actually didn’t expect to heat back, but thought it couldn’t hurt to try.. :] Glad I did. Your points both make sense, although I think I still have a different opinion as you on the second (theoretically, similarly, certain barrier methods on contraception would be justified, although I morally reject them, whether there could feasibly be a positive or not), but that’s not something that’s fact-based, so it seems no further questions would be needed or helpful. I do see the point, actually, about how illnesses strike when very young and, after reading it, am kind of surprised at how it’s never presented itself before, as simple as it is.. We somewhat recently have decided to stop straddling the fence (and by default siding with not vaccinating) and to get the vaccinations done, save for the two or three that are morally objectionable (for Catholics, if you happen to follow such things), but I still have reservations/doubts.. You’ve actually helped a lot with that first bit! Thanks :]


    (and thank you to Maralee for noticing the comments and asking for a response!)

    (and sorry for the various weirdities I didn’t notice while typing on my phone!)

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