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Risking deadly diseases

Science | To vaccinate or not to vaccinate is a needling question for many parents

Issue: "Between Hell and Hope," Feb. 12, 2011

Katie and Craig Van Tornhout of South Bend, Ind., suffered four miscarriages before Katie became pregnant with Callie Grace, born Christmas Eve 2009. Callie was six weeks premature, but after a week and a half at the hospital, she came home and gained a pound a week. "She just thrived," said Katie, 31. "She giggled. She was just the happiest baby."

One month later on a Sunday, Callie let out a single, light cough. It didn't seem serious, but as a conscientious, first-time mom, Katie visited a doctor the next day, who assured her the baby's lungs were clear. But midweek, Callie briefly stopped breathing. Doctors in the pediatrics intensive care unit at a local hospital ran tests on the baby, trying to identify her disease, but on Friday night Callie quit responding. Despite 45 minutes of CPR by hospital staff, she couldn't be revived.

"When the doctor comes to you with tears in his eyes, you know that it's bad," said Katie. Test results later showed Callie had pertussis, a bacterial infection of the respiratory system that is highly contagious and widely known as whooping cough.

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Last year the Van Tornhouts' tragedy wasn't quite as rare as usual. Outbreaks of whooping cough-named for the gasping sound sometimes produced by coughing fits-occurred in Ohio and Michigan, and in California the rate of infection spiked to its highest since 1958. The disease claims about 20 U.S. lives each year, mainly newborns, but last year 10 infants died in California alone. Since a pertussis vaccine is routinely given to children 2 months and older, many observers hastened to blame the outbreaks on a subset of parents who refuse to vaccinate. Most doctors strongly recommend vaccines, but some understand parents' apprehension and say blaming them is misguided.

In response to the outbreak, California passed a law requiring all seventh- to 12th-grade students to have their pertussis immunization up-to-date for the coming school year-or fill out an exemption form. All 50 states mandate immunization for new school children, according to the National Conference of State Legislatures, but most allow parents to sign an exemption if they object to vaccination on grounds that are religious or "philosophical"-meaning at odds with most of the medical community. The percentage of children using these exemptions more than doubled from 1991 to 2004.

In California, the parents of about 1 in 50 kindergartners sign exemption forms for one or more vaccines. But in some communities the sentiment is stronger: In 2009, 175 schools in the state had exemption rates of 20 percent or more, and a few surpassed 70 percent.

The exemption trend worries immunologists, who say that for diseases like pertussis an inoculation rate of about 93 percent is needed to achieve "herd immunity," where transmission is slowed enough to prevent an outbreak.

While nine out of 10 parents follow their doctors' vaccination advice, about half are concerned that some vaccines aren't safe, according to a 2009 survey. Do these parents have reason to worry?

Maybe. Like many drugs, some vaccines don't work well in everybody and come with serious, if rare, side effects. The whooping cough vaccine currently used in the United States on infants and children under 7 is a combination of diphtheria, tetanus, and acellular pertussis vaccines, abbreviated as DTaP. According to the U.S. Centers for Disease Control and Prevention, the side effects of DTaP include seizures in 1 in 14,000 children, three or more hours of non-stop crying in 1 in 1,000 children, and serious long-term injury in about 1 in 1,000,000 doses. The National Vaccine Injury Compensation Program, funded by a nationwide vaccine tax and housed at the U.S. Department of Health and Human Services, has awarded $2 billion to over 2,500 families for non-autism vaccine injuries since 1989. The injuries range from allergic reactions to neurological damage to unexpected infant death. (Most claims are dismissed, however, and whether the vaccines are at fault is often in dispute.)

"For many years the medical community denied that severe vaccine reactions were even possible," said Bob Sears, a pediatrician in Capistrano Beach, Calif. and author of The Vaccine Book: Making the Right Decision for Your Child. "No parent wants their child to be a disease statistic, but they also don't want their child to be a vaccine reaction statistic, either."

Sears said the medical establishment today is more forthcoming about the reaction risks, though he'd like to see more independent research on vaccine safety. However, he recommends vaccines to parents because he believes the benefits outweigh the risks.

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