What are these parents thinking? What are the pediatricians saying in response?
Why does the American Academy of Pediatrics and the Centers for Disease Control recommend multiple vaccinations in the first 6 months of life? It’s about risk to the child. As every physician should know, an infant is born with a very weak, unchallenged adaptive immune system. Protection is from maternal antibodies and the innate immune system. If there are no or low levels of maternal antibodies, then the infant is highly vulnerable to potentially fatal vaccine-preventable infections.
A second scenario is the parent who requests that no more than one or two shots be given to their child at a single visit. The parents make this request based on information from the media and endorsed by well-meaning pediatricians. The supposed threat to the child is that too many shots might overwhelm the immune system. This notion has absolutely no evidence. To the contrary, there is a requirement by the Food and Drug Administration that whenever a new vaccine is added to the schedule and is to be administered in a combination or as an additional injection, the vaccine must be proven to be as safe and as immunogenic. If a new vaccine is to given concurrently, it must be proven to be as safe and as immunogenic or the vaccine cannot be added to the endorsed pediatric vaccine program.
What age is the highest risk for a fatal infection from pertussis? It is in the first 6 months of life. What is the second highest risk for a fatal infection? It is between 6 and 12 months of age. The answer is the same for all the infections we vaccinate against in the well-studied and evidence-based 2-, 4-, and 6-month primary series schedule. There is mention of pain of the child with "too many shots." I have seen the pain of an infant with pertussis paroxysmal cough. The child literally coughed to death. I have seen an infant asphyxiate from diphtheria. I have seen an infant with convulsions from tetanus that could not be stopped, and the hyperpyrexia caused severe brain damage. I have seen Haemophilus influenzae type b, and pneumococcal and meningococcal meningitis in infants. Many died and many of those who lived had devastating neurologic consequences.
So when parents ask to delay vaccinations or refuses vaccinations, they are putting their children at risk. Is this parental neglect? Did the pediatrician have the parents sign a waiver acknowledging they understand the risk? And, when the pediatrician agrees, is this a responsible decision? Is the pediatrician agreeing to put the child at risk, as well as other children in the waiting room? And if the child contracts a vaccine-preventable infection, whose fault is it?
Michael Pichichero, M.D., a specialist in pediatric infectious diseases, is director of the Rochester (N.Y.) General Research Institute. He is also a pediatrician at Legacy Pediatrics in Rochester. Dr. Pichichero said he has no relevant financial disclosures.
