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Some doctors, patients fight against anti-vaccine movement
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Becky Stratman of Squirrel Hill with 1-month-old son Xavier after he received a hepatitis vaccination. -
Dr. Julius Youngner -- In the 1950s and 1960s, he says, parents were much more afraid of the diseases themselves than of the vaccines. -
Dr. Todd Wolynn, a pediatrician at Kids Plus Pediatrics in Greenfield, insists that parents of the children he sees basically follow the official vaccination schedule. -
Medical assistant Khaliah Gilbert, right, and Becky Stratman of Squirrel Hill work together to make sure that Ms. Stratman's 1-month-old son, Xavier, is comfortable as he receives a hepatitis vaccination at the Kids Plus Pediatrics office in Greenfield.
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In the face of increasing evidence that families who oppose vaccination are endangering their own children and public health, some doctors and patients are starting to fight back.
One new study says that a fifth of all families are now delaying recommended vaccinations for their children, and in some pockets on the West Coast, 20 to 30 percent of the residents are unvaccinated.
As a result, California is now experiencing its worst whooping cough outbreak in 50 years, with nearly 9,000 people infected and 10 children dead, and Pennsylvania's cases jumped more than 50 percent last year, to 950.
The continuing resistance to vaccines has produced two new books, both of which come down soundly on the side of the safety and effectiveness of vaccines for diseases that once killed thousands of people.
New revelations this month have further discredited British researcher Andrew Wakefield, who triggered many of the vaccine fears with his claim that the measles-mumps-rubella vaccine might cause autism.
And nationally, an increasing number of pediatrics practices are insisting that parents follow the official vaccination schedule.
At Kids Plus Pediatrics in Greenfield, Todd Wolynn and his fellow doctors have a policy that parents must comply with all childhood vaccinations, although they give them a slight amount of leeway on timing.
He said the group decided about three years ago to adopt a standard policy on vaccinations, partly so that parents couldn't "go shopping" for the physician who would be the most lenient.
While there are some pediatricians who have adopted a "my way or the highway" stance on giving vaccinations on the official federal schedule, Kids Plus will allow parents to space out vaccinations between each standard visit, but by each deadline -- at two months, four months and so on -- they have to be caught up on their immunizations.
As part of the education process, Kids Plus doctors and nurses explain that even though the recommended schedule calls for up to 10 different vaccines in the first 18 months of life, improvements in the way vaccines are made have reduced the total number of immune-activating substances in those shots to about 4 percent of the amount that children got in 1960 from just five vaccines.
Since the Kids Plus policy went into effect, the group has lost fewer than 1 percent of its families, Dr. Wolynn said. And now, the staff can assure their remaining parents that their children won't get a disease from an unvaccinated child in their waiting rooms.
One Kids Plus parent said last week that she heartily endorses the rules.
Holding her chubby 1-month-old son, Xavier, Becky Stratman said she had worked as a pediatric nurse for 10 years, and had seen the consequences of preventable diseases up close.
"I've had to take care of babies who had pertussis, and it was a horrible experience," she said.
Pertussis, another name for whooping cough, is covered by the diphtheria-tetanus-pertussis vaccine, but babies can get it before their inoculations through contact with an unvaccinated adult or older child.
"I remember one 1-month-old," Ms. Stratman said, "and she would start coughing up fluids and would go completely blue and she could not catch her breath and you'd have to let the spasm pass. Luckily, she did survive it, but a lot of them ended up in the ICU."
In one sense, Ms. Stratman is typical.
A study last year in the journal Pediatrics showed that 90 percent of Americans believe vaccines are a good way to protect children from disease, and 88 percent do what their doctor recommends on inoculations.
But unlike Becky Stratman, 54 percent of the parents who were surveyed said they were worried about the effects of vaccines, and 25 percent still believed vaccines could cause autism in healthy children, despite study after study that has demonstrated otherwise.
Many of those fears have been heightened by years of anti-vaccine comments from a small group of celebrities and other activists. But now, other voices are starting to emerge more strongly.
The new books on the subject are "Deadly Choices: How the Anti-Vaccine Movement Threatens Us All," by Paul Offit, an infectious disease specialist at Children's Hospital of Philadelphia, and "The Panic Virus: A True Story of Medicine, Science and Fear," by magazine journalist Seth Mnookin.
Their books come at a time when there is an unsettling decrease in "herd immunity" in the American population. When vaccination rates are high, it doesn't matter if some individuals get preventable diseases, because they won't be able to spread very far.
But more and more often, these infections are getting a foothold, Dr. Offit said in a recent interview.
In 2008, he said, a child from California contracted measles on a trip to Switzerland and then started a mini-epidemic when he returned home. "It wasn't surprising that measles came into the U.S. -- that happens all the time. What was different about the San Diego incident was that you had one child passing the infection to another unvaccinated child to another unvaccinated child."
When these incidents are scattered, though, they may fly under people's radar, said Gregory Poland, an infectious disease specialist at the Mayo Clinic in Minnesota.
"Let's take a young infant," he said. "For them, pertussis is a deadly disease because their airways are so small. Similarly, about three of every 1,000 people who get measles die from it. The anti-vaccination movement has been able to sustain itself because at a population level, those deaths are rare enough that people don't see them."
Dr. Wolynn, at Kids Plus, agrees.
In lectures he gives around the state, doctors tell him about 15 to 20 percent of their patients say they are worried about vaccines. But "many of them don't say anything, because it's a volume business and they feel, 'I've got to get on to the next patient,' " he said.
The anxiety about vaccines today is a far cry from 60 years ago, said Julius Youngner, who helped develop the Salk polio vaccine and still lives in Squirrel Hill.
In the 1950s and 1960s, Dr. Youngner said, parents were much more afraid of the diseases themselves than of the vaccines, particularly when it came to smallpox and polio.
"When you have a disease like smallpox where 30 percent who get the disease die, and you have this terrible scarring with the survivors, vaccine eradication becomes very popular," he said.
And because polio could paralyze children, it caused equal fears and a great thirst for the Salk vaccine when it was developed. "In the field trials here in Pittsburgh, we vaccinated 10,000 children, and we never had anybody who said, 'Don't do this; this is dangerous.'
"But then later, when a disease sort of disappears and it's not a factor in your consciousness, you ask, 'Why should my kid get these three injections?' But you know, polio is still a problem in Nigeria, and somebody from there could be in New York in nine hours."
Amy Pisani, executive director of the pro-vaccine advocacy group Every Child By Two, based in Washington, D.C., said she believes mothers in the 1950s and 1960s were also more likely to be at home and form strong neighborhood communities, "whereas now it's every person for himself. Maybe that is where society is moving."
Despite these challenges, Mayo's Dr. Poland believes it is possible to change parents' minds.
He differentiates between "the vaccine refusers and what I call the vaccine-hesitant. I've found the vaccine-hesitant parents can be reached with targeted education."
Recently, Dr. Wolynn at Kids Plus has seen mainstream parents start to push back, particularly on the practice's Facebook site.
"If you put your finger on the pulse of the general population that is very supportive of vaccines," he said, "they are starting to get pretty irritated that they can be put at risk by people who take advantage of the fact that everyone else around them is being immunized."
First Published January 23, 2011 12:00 am
