More Oregon parents delaying vaccines

Nearly 10% of parents in Oregon are limiting their children to getting no more than one or two injections per visit to the pediatrician, according to a new study published in the medical journal Pediatrics Monday.  

As a result, children are falling behind in getting recommended vaccines, which could leave them vulnerable.

Researchers analyzed immunization records from 97,711 children born between 2003 and 2009 and found that parents in the greater Portland area choosing to restrict the number of shots their infants get during the first 9 months of life grew from 2.5% in 2006 to 9.5% in 2009.

By limiting the number of injections, parents are choosing to deviate from the vaccine schedule recommended by the CDC, the American Academy of Pedictrics (AAP) and the American Academy of Family Physicians.

Researchers say this study is the first to quantify how many babies are consistently getting vaccines on a delayed schedule.  Data about children who weren't getting any vaccines at all were not included in this report.

Lead study author Steve Robison says he was surprised that the number of parents who are limiting vaccine injections was so high.

Robison, an epidimiologist with the Oregon Health Authority, says some parents may be following recommended alternate vaccination schedules as suggested by Dr. Stephanie Cave or Dr. Robert Sears, who in 2001 and 2007 respectively began recommending that children only receive one vaccine per doctor's visits and delaying or avoiding some vaccines.

Three years ago, Pediatrics published an article in which two researchers address what they call "The Problem With Dr. Bob's Alternative Vaccine Schedule." In it, they say stretching out when children get vaccines will "increase the time during which children are susceptible to vaccine-preventable diseases," resulting in fewer children who are protected, "with the inevitable consequence of continued or worsening outbreaks of vaccine-preventable diseases."

Currently the CDC's Advisory Committee on Immunization Practices (ACIP)  recommends children get multiple vaccines at their 2, 4, 6 and 12 months well-baby visits.

The study authors found many parents weren't actually sticking to the Sears or Cave schedule either, suggesting "parents are unable to accommodate the extra visits needed to space out vaccinations according to alternative schedules because parents are customizing their own schedules."

The study found that babies on the delayed vaccine schedule received on average only six vaccination injections during four doctor's visits, compared to about 10 vaccinations over three visits when parents allowed for the regular schedule to be followed.

"It may be appealing to follow an alternate schedule, but it's too easy fall behind on shots, and it's really hard to catch up once you're behind," Robison says.

As more vaccines have been developed and added to the schedule, so has the fear among some parents that instead of preventing illness, these drugs are causing children to get sick, particularly since controversial British physician Dr. Andrew Wakefield suggested there was a link between the measles-mumps-rubella vaccine and autism in a discredited study.

The CDC does not endorse any alternate vaccine schedules.

"There's no evidence whatsoever that that getting multiple antigens is bad," says and Dr. Paul Cieslak, medical director for the Immunization program for the Oregon Health Authority and a recent member of the CDC's Advisory Committee on Immunization Practices, which has been developing the recommended vaccine schedule since 1995. Antigens are bacteria or viruses that help a child build up immunity.

Cieslak says there's a reason for how the CDC and AAP endorsed vaccination schedule is set up: "The schedule is a balance between when you need vaccines and practical considerations like when is a child likely to visit a doctor."

Cieslak, who was not involved in the study, explains that if you follow Sears' schedule, for example, you have to take your child to the pediatrician nine or 10 times during the first year of life. He says for many parents it's hard enough to get to the five recommended appointments on the well-baby schedule.

He is aware that some parents fear having their child exposed to too many antigens at one time. But he also reminds them that when a child is crawling on the floor or eating his or her first mouthful of dirt – which will happen – the child is exposed to hundreds of bacteria and bugs, which the immune system has to deal with.

Cieslak also points out that vaccinations according to the CDC/ACIP schedule are recommended precisely at the time when infants are at highest risk of serious illness. "If you get pertussis during infancy... [babies] cough and cough and cough, and when they're coughing so much they can't get a breath because you only exhale when you cough."

He says in Oregon about about 50% of infants with pertussis land in the hospital and occasionally there's even a death.

Cieslak applauds the vast majority of parents who are following the schedule as recommended. To them he says: "Good job! You're getting your kids immunized and helping to protect the kid next door as well."