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Vaccination Guest Post: Whooping cough outbreak and kids who require special consideration

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This is a series of guest posts by Dr. Mark McColl on vaccination issues.  Please read my vaccine history and introduction of Dr. McColl before continuing.  You can also read his previous posts on his vaccination choices for his kidsethics and parental rights, and delaying vaccinations.  These questions were all submitted by blog readers.  Enjoy!

Is the current whooping cough outbreak related to parents choosing not to vaccinate?

Yes.  For example, in 2011 in California, ten infants died after contracting whooping cough from their parents.  There were probably more children who contracted the disease from their parents but in these ten cases it was documented that their parents were encouraged and counseled to receive the whooping cough vaccination for themselves prior to the infant’s birth.  If their parents had chosen to vaccinate themselves it is very unlikely their children would have contracted the illness nor died from it.  Imagine the pain of these mothers when they look back on their decision and wanting to choose differently?

Benjamin Franklin had a similar experience with small pox killing his son, Franky.  He wrote “In 1736 I lost one of my sons, a fine boy of four years old, by the small-pox, taken in the common way.  I long regretted bitterly, and still regret that I had not given it to him by inoculuation [sic].  This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it, my example showing that the regret may be the same either way and that, therefore, the safer should be chosen.”

For children born very prematurely, is there wisdom in delaying some vaccinations to compensate for their adjusted age? Are vaccination risks greater for preemies?

For premature children the risk of remaining unprotected against preventable diseases is actually greater than for children born at term.  They lack much of the natural immunity delivered in the last month of pregnancy.  They certainly lack much of the nutrition given to them during that last month.  Most vaccinations do however have a weight limit for which it has been adequately studied.  In general, vaccinations are delayed until the child is at least 2 kilograms (4.4 lbs).  Practically this only applies to the Hepatitis B vaccine and is the data from which we established the weight limit.  There is no increased risk of adverse reactions to vaccinations in children born premature compared to full term children.

While most pediatric medications are dosed according to the child’s weight, vaccinations are not.  In general the amount of material we need to present to the child’s immune system is so small that you can’t limit the dose any further.  For instance, when a child acquires pertussis (whooping cough) there are over 3000 particles in the bacterial cell to which the body can and often does produce an immune reaction.  In the vaccine for pertussis, only three proteins are necessary to adequately build protection against death from this disease.  The concentrations of these three proteins are similarly small compared to the levels seen when infected or otherwise exposed naturally.

In some instances, adults need larger doses of these stimulating proteins in order for their immune system, which is admittedly slow and groggy, to appropriately react to it.  The is even more true for the elderly who’s immune systems seem to be the sleepiest of all.

What children should NOT receive vaccinations?

Children with a clear medical contraindication to vaccination should not receive the vaccine.  Children allergic to a component to a vaccine should not receive that vaccine but should receive all other vaccines.  Thankfully, allergies to vaccine components are uncommon with current purification techniques.  Children with a prior serious adverse reaction to a vaccine such as seizure should avoid that vaccine.  These reactions are rare and typically occur in approximately 1 out of 100,000 to 1,000,000 vaccinations.

Why should a Christian family get their daughter vaccinated against HPV?

For the same reason she should wear her seatbelt.  She is most likely to be harmed not when she chooses poorly but when someone else does.

When my daughter gets old enough her mother and I plan on her receiving the appropriate vaccination against Human Papillomavirus.  We have already begun teaching her to be a wise, modest, and chaste young lady.  We want her to love God with all her heart and mind and soul and strength.  We teach her to do everything to the glory of God.  So if she choses a perfect path through the minefield of adolescence and young adulthood and marries a similarly wise and pure young man, then the HPV vaccination would have been unnecessary.  I will rejoice happily if that comes to pass.

However, I do not know how well my daughter will make her decisions and I do not know who that young man will be that will steal her heart.  I can’t ensure he is receiving similar wise counsel and will make chaste choices about his sexual purity too.  It is his decision that will cause her to be at risk of cervical cancer.  My daughter may choose a perfectly pure path until her marriage and still die of cervical cancer.  All because this boy didn’t make the same good decisions.

A seatbelt protects us against our own bad decisions but protects us against everyone else’s bad decisions too.

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9 Comments

  1. The mention of a number of infants contracting pertussis from their cargivers made me think of this…
    One thing I’ve often wondered is why there isn’t more of a campaign to inform adults of the need to stay current on vaccinations. I was offered a TDaP (or whatever they call the adult one) shot when I gave birth to my fourth, but prior to that I’d never even heard of it (and all my babies were born during “sick season”).
    Also, last spring my husband got the mumps from his boss. He expressed confusion at being able to contract something he was immunized against as a child, and was shocked when I informed him that vaccinations don’t necessarily confer permanent immunity. Actually, a number of friends of ours were surprised to learn this as well. I wonder if Dr. McColl could speak to why there is not a greater effort to make adults aware of the need to stay current on vaccinations as well.

    • Meagan, the campaign to inform adults about vaccinations is ongoing but difficult. I practice both Pediatrics and Internal Medicine and I know that questions about vaccinations are part of every physical or preventive heath visit I perform. Most adults are like your family and friends and surprised to find out they may need vaccinations just like their children do. Quite frankly though it is much harder to convince an adult to receive a needed vaccination then it is to convince a parent to give it to their children. The majority response I get is “Let me think about it” for years on end. Interestingly, there is a high rate of vaccination in new grandparents though. They don’t want anything standing in the way of seeing their new grandchild. Travelers aboard often are aware of their need for updated immunizations too. They perceive an increased risk because of their travel plans and want to be better protected.

      Specifically to your comment about Tdap with your fourth pregnancy, the campaign to immunize adults against whooping cough (pertussis) really started in 2005-2006 and it was just in the last few years that OBs and birthing centers got on board and starting routinely offering it at the time of delivery. The current recommendation is that adults receive a one time booster for whooping cough as an adult but we’re still waiting to see how the immunity holds 10-15 years later. We may or may not need continued immunization.

  2. That is a very interesting idea to me — that people are more easily convinced to have their children vaccinated than themselves. I wonder why that is.
    I put far more thought and concern into what I allow to be put to my children’s bodies (whether that be medicine, food, etc) than I do my own. I didn’t think twice about the Tdap when it was offered to me, while I did extensive research regarding vaccination for my children. It’s curious to me that that isn’t more of a norm!

    Thank you for your response – I appreciate your contribution to this series!

    • I wonder if we’re more likely to vaccinate our kids because we see them as vulnerable to disease, but we think of ourselves as strong enough to fight it off. At least I know that’s my flu shot reasoning.

      • I wonder if part of it too is that most adults, I would guess, don’t have regular physicals like kids do, so perhaps hear far less often about adult vaccination/boosters.

        • That would definitely be the case here. 🙂 I can’t say that either my husband or I have had a routine doctor’s visit in the last 10 years (aside from about a million OB visits for me).

  3. I’ve been thinking a lot about the HPV vaccine… Thanks, Dr. McColl, for your advice–itt’s really helpful.

  4. Thank you Dr. McColl for your info. I am wondering what your thoughts are on the HPV vaccine for boys. I just recently turned it down for my 11 year old son but would like your views coming from a Christian doctor’s perspective regarding whether a boy needs it. Thanks!

    • The HPV vaccine for boys is promising but not quite were I personally want it to be to recommend it. Since it is not required by our state for boys or girls I typically offer it to parents of teenage boys and then explain why I’m not excited about it. Some still take it but most don’t.

      The two licensed HPV vaccines both protect against either 2 or 4 strains of the Human Papilloma virus. The hope for the vaccines was to protect boys by keeping them from acquiring the viral infection. If the boys don’t get the viral infection they can’t spread it to their sexual partners. So far the studies don’t show that the vaccines reduce the transmission of HPV to female sexual partners very well. Therefore the risk of cervical cancer remains about the same.

      HPV vaccine for boys has been shown to reduce the incidence of genital warts in boys which is not a disease you want but is a non-fatal disease. This would be the only vaccine in the line up which would then be used to protect against something that doesn’t kill you. That’s a big distinction in my mind. Fundamentally, I believe there are better ways to protect against genital warts (abstinence and then monogamy).

      HPV vaccine in boys has also been shown to reduce the rates of anal and rectal cancer in receptive homosexual men. So if I have a patient with that sexual orientation it might be advisable for him to receive the vaccine although I would still counsel him on the dangers of his sexual practices.

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