Recommended vaccination schedule not followed in 1 of 4 children

Using alternative vaccination schedules, or refusing vaccinations altogether, is certainly a common problem not only in New York state, but also across the country. We’ve lost an understanding, both on the part of the public and on the part of health care providers, as to why we even have schedules. We have them because it’s about trying to gain protection for children as quickly as possible against the diseases they’re most likely to contract after the immunity protection from the mother wanes, which happens even if the mother is still breastfeeding. This idea of getting the vaccinations on schedule – for example, at age 2 months, 4 months, and 6 months – is specifically intended to achieve the goal of immunity by the time that protection from the mother has waned.

Because the schedule has been handed down by the American Academy of Pediatrics and the Centers for Disease Control and Prevention as “recommended” with no detailed explanation why, many pediatricians are unaware of the immunology and all the research that went into creating the schedule. It requires the health care provider’s agreement and the parent’s request to have the results shown in this study, where one in four children intentionally deviated from the routine schedule. If a parent asks me to deviate, I have the knowledge as an immunologist and infectious disease specialist to explain why I don’t think that’s a good idea. And when I do, the parents agree to the routine schedule. But if you’re not informed as to why, then you have other information from sources that are not as well informed, recommending all these alternative vaccination schedules.

We, as health care providers, can never force a parent to do something. There should be discussion between provider and parent to inform the latter of the risks of delaying vaccinations or following alternative schedules. The unfortunate thing is that by not following the recommendations, the parent is making the child more susceptible to contracting the very disease she should have been vaccinated against. I’m aware of a recent case in which an alternative schedule was used, but the child did not achieve full immunity, and as a result, contracted bacterial spinal meningitis and died. Now that parent feels tremendous guilt, and the doctor in charge of caring for the child also feels guilt and wonders if pushing the parent harder to stick to the recommended schedule would have saved the child’s life.

There was also a recent research study that surprised everyone – by Nyhan B et al. (Pediatrics 2014;133:e835-42) – because we’re searching for a way to solve all these problems that we’ve encountered over the last 10 years or so in achieving more complete and more timely vaccination. But the findings of that study were disappointing because the investigators tried several different approaches to achieve that outcome, but none of them worked. And, in some cases, trying to educate parents about certain misconceptions or correcting false information turned out to be counterproductive.

Dr. Michael E. Pichichero is a specialist in pediatric infectious diseases and is the director of the Research Institute at Rochester (N.Y.) General Hospital, as well as a pediatrician at Legacy Pediatrics in Rochester. He was asked to comment on the article by Dr. Nadeau et al. Dr. Pichichero said he had no relevant financial disclosures.