Q.  I've been reading a lot of very scary information about vaccinations. What's your opinion on the current vaccine schedule? I have read about possible links between the MMR vaccine and autism, and am considering having the vaccine broken up, but if it's not necessary, I would prefer that my child not have the shots at all. What are your thoughts?

A. When I graduated from medical school, many of the current vaccines were either not yet invented or just beginning to be widely used. I still remember what health care was like in the pre-vaccine era, and I remember that there seemed to be at least one child in each neighborhood who spent much of her life in an iron lung because of polio. As a young resident in pediatrics, I heard, on the whooping-cough ward, the coughing and choking of children with pneumonia. I remember the brain damage from encephalitis caused by measles, and the birth defects of babies whose mothers had had German measles during pregnancy. In my first years in pediatric practice, I remember making hospital rounds every morning and treating children with meningitis, and complications of chicken pox and other illnesses that have been either eliminated or lessened in severity by the widespread use of vaccines. Also, I remember more than a decade ago when Great Britain temporarily stopped the routine use of the DTP vaccine because of a reaction scare (which later turned out to be a false alarm) and consequently suffered a resurgence of whooping cough. Because of my "historical" perspective, I have grown to appreciate the value of vaccines as a necessary public-health measure. Currently in our pediatric practice, we follow the [XREF {/parenting/checklists/immunizations1.html} {vaccine schedule recommended by the American Academy of Pediatrics.

Immunizations stimulate your child's immune defenses to produce antibodies against germs that cause particular illnesses. A vaccine is created by weakening or killing the disease-causing germs. These altered germs are weak enough to stimulate the production of antibodies, yet are not strong enough to cause the illness itself. If the real germ enters the body after a vaccination, the antibodies produced by the vaccine will be able to fight the germ, and no disease or only a mild disease will result. Every vaccine (and, in fact, any substance that's put into a child's body, such as a new medicine or food) has both risks and benefits. When doctors and vaccine policy makers are evaluating a vaccine, they try to weigh the benefits of the vaccine vs. the risks. The only vaccines that are licensed are the ones in which the benefits to the general population for eradicating the disease outweigh the potential risks. The goal of worldwide vaccination policy is to eventually eliminate or at least reduce the prevalence and severity of diseases. A good example of the benefit of such worldwide policies is the smallpox vaccine. Many years ago the risk of death or serious illness from smallpox was much higher than the risks associated with the vaccine. Because vaccination against smallpox became a worldwide policy, the disease was eradicated, and eventually the risk associated with the vaccine outweighed the extremely small risk of contracting the disease, so routine smallpox vaccination have been discontinued. Polio is following a similar course, and, within the next decade, it's possible that routine polio vaccinations may no longer be needed. A recent outbreak of polio in the Dominican Republic, however, may prevent this from happening.

Immunizations have received a lot of bad press lately. Bad news makes headlines, yet the fact that millions of children have been spared from what used to be routine disease doesn't get much press at all. Today, parents who want responsible medical care for their children are often confused by scary and misleading vaccine news. Much of what you might have heard or read about vaccine reactions is grossly exaggerated, unsubstantiated, or, perhaps, is about vaccines that are no longer used. For example, the new DTP vaccine, (called the DTaP or acellular DTP), has replaced the old DTP (the one that received a lot of bad press) since it has a significantly lower risk of reaction. The most recent alarming media reports discussed an alleged link between autism and the measles-mumps-rubella (MMR) vaccine. To responsibly and scientifically address this concern, the American Academy of Pediatrics (AAP) Committee on Infectious Diseases convened a panel of experts to review data on whether there were possible associations between MMR and autistic spectrum disorder. The conclusion of this panel, published in the May 2001 issue of AAP News, was that the available evidence does not support the concern that the MMR vaccine causes autism or autism-associated disorders. They also added that there is no evidence to support the alleged link between the MMR vaccine and inflammatory-bowel disease. In a study in the March 7, 2001, issue of the Journal of the American Medical Association, researchers examined children receiving the MMR vaccine from 1980-1994 in California and concluded that the data does not suggest an association between MMR immunization and autism. The AAP panel also concluded that separate administrations of measles, mumps and rubella vaccines to children would provide no benefit and may result in delayed or missed immunizations.

Perhaps the one-size-fits-all vaccine policy may not sit well with every family, yet it's prudent to have an overall vaccine policy. It's best to discuss your individual concerns with your child's doctor, though, since there may be medical and lifestyle circumstances within your family that warrant individualizing your child's vaccination schedule.