What Is the Harm in Delaying or Spacing out Vaccines?
Alternative Vaccine Schedules: Are They Safe
For parents concerned that their babies are getting too many vaccines at once, there are alternatives to the recommended vaccination schedule. Yet many medical authorities do not endorse them.
By Chris Iliades, MD
Medically Reviewed by Cynthia Haines, MD
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The Centers for Disease Control and Prevention (CDC) and its Advisory Committee on Immunization Practices (APIC) recommend that babies receive 14 vaccines before the age of 2. The vaccines are given in a series of 26 shots, with as many as five shots at a single visit. Some parents are concerned that this vaccine schedule may overwhelm a child's immune system. Others believe vaccines are behind the rise in other medical conditions, like autism. This has created heated debate between organizations like the American Academy of Pediatrics (AAP) and the few pediatricians who have offered alternative vaccine schedules that either eliminate certain vaccines or delay the schedule for these baby shots.
Alternative Vaccine Schedule: What Is It?
In his book,The Vaccine Book: Making the Right Decision for Your Child, pediatrician Robert Sears, MD, outlines two alternatives to the traditional vaccine schedule. The "Selective Vaccine Schedule" omits certain vaccines, while the "Alternative Vaccine Schedule" stretches out the traditional one.
Through his book and Web site, Dr. Sears addresses questions about vaccines, the overall number, the combinations of vaccines given in a single dose, and the preservatives in some vaccines, which contain mercury and aluminum. Some parent groups have pointed to the increasing number of children being diagnosed with autism and autoimmune diseases as a possible consequence of these vaccines. In a recent case, however, the U.S. Court of Claims ruled that the evidence overwhelmingly contradicted parents' claims that MMR (measles, mumps, and rubella vaccine) was to blame for their children's development of autism.
A recent article inPediatrics, the official journal of the AAP, challenges many of Dr. Sears' opinions and offers science behind the traditional schedule. One example concerns the meningitis vaccine, which Sears does not recommend for teens because of the possible — one in one million — risk of Guillain-Barre syndrome. The article notes that the risk of meningitis is 10 times as high, and the disease is often fatal.
Alternative Vaccine Schedule: The Pros and Cons
Here, we take a look at several selective and alternate vaccine schedules and discuss the pros and cons of each.
Decline live-virus vaccinations and eliminate vaccinations for less serious diseases.
Pro:Proponents believe live-virus vaccines are unsafe and that it's better for children to get diseases like chicken pox than the vaccine to prevent it.
Con:It takes only one case of polio coming into the United States for the disease to come back here, states the AAP; there have already been outbreaks of measles in some parts of the country because kids weren't given these shots.
Separate combined vaccines such as the MMR so that children get only one live vaccine at a time.
Pro:Giving only one live-virus vaccine at a time may allow the baby's immune system to better handle live viruses.
Con:The AAP says that babies are exposed to and fight off thousands of germs, or antigens, every day, far more than the few that are in any combination vaccine.
Spread out vaccines so that no more than two vaccines are given at one time.
Pro:This may decrease side effects and, if there is a reaction, make it easier to pinpoint which vaccine caused it.
Con:A longer schedule leaves babies at risk longer than necessary. In some cases, kids won't get a measles vaccine until age 3 or a flu shot until age 5, yet thousands of kids over age 4 are hospitalized every year because of flu complications. Spacing out the shots and limiting them to two per visit also means 12 visits to the doctor by age 2 and 7 more between ages 2 and 6.
Avoid some booster shots by doing a blood test to see if the shot is really needed.
Pro:This may make booster shots unnecessary if the vaccine is still active.
Con:Tests that check for immunity to certain diseases do not work well in young children, says the AAP.
Sears feels the slower pace will encourage parents to get their kids vaccinated, while the AAP believes it will lead to a decline in immunization rates because of the extra visits and co-pays.
Alternative Vaccine Schedule: Does It Work?
The CDC vaccination schedule is supported by the AAP and the American Academy of Family Physicians. The advisory committees that make the vaccine recommendations have expertise in all the medical sciences — such as virology, microbiology, statistics, and epidemiology — needed to review the research studies that lead to their recommendations. The CDC schedule was designed to work with children's immune system at certain ages and at specific times. According to the AAP, there is no scientific evidence to support the alternate schedule, so there's no way to know how it works to protect children.
Angie Matthiessen, MSW, program coordinator of Immunize Georgia at Children's Healthcare of Atlanta, is a vaccination expert and a passionate supporter of the vaccination program. She says, "These vaccines and how they are given are the product of extensive, solid research done by the top medical doctors and public health experts. The CDC vaccination program for children is one of medicines' greatest success stories. Our only motive is to make children's lives better and safer."
Matthiessen says that our vaccines today are really much smarter than in the past. She points out that the smallpox vaccine given in 1900 had more of an impact on the immune system than the combination of all the vaccines we give today. "The diseases these vaccines prevent are real and they are dangerous. Some are being seen in communities across the country and are just a plane ride away. Vaccines are meant to be given when they can provide the most protection at a time when babies are the most vulnerable to disease," she adds.
Alternative Vaccine Schedule: Making an Educated Decision
Karen Medeiros of Danbury, Conn., has followed the CDC vaccination schedule with her four children, including 4-year-old twins. "I'm aware of the controversy and I wouldn't have minded spreading out some of the shots. It's hard to see your babies get all those injections," says Medeiros. She thinks that a lot of the controversy is media-driven. "I heard that we don't need to give the polio vaccine anymore because we don't have polio. But it only takes some common sense to realize that people are coming into our country from other countries that still have polio."
Medeiros learned about the risks and benefits of the vaccination schedule and discussed it with her pediatrician. "I decided that I trust my pediatrician's judgment — we have always had a good relationship. In the end, I believe that my doctor is interested in the same thing I am: what's safest for my children based on the best medical evidence available."
If you are concerned about the CDC vaccination schedule, learn as much as you can from reliable and current sources, suggests Matthiessen. is a Web site launched by the public awareness group Every Child By Two, founded by former first lady Rosalynn Carter and former first lady of Arkansas Betty Bumpers. Another source of information is Johns Hopkins Bloomberg School of Public Health's .
Each vaccine has its own insert that outlines the possible side effects and conditions in which the vaccine should not be given. If you are concerned about the mercury-containing preservative (thimerosal) that is still in the flu shot, you can ask your doctor to use a vaccine without it.
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