Immunization is a subject that evokes very strong
opinions and usually stirs up heated debate as to their efficacy,
safety, and reliability. The main questions parents have to
answer are whether to immunize or not, and if so, when and with
It is vital that doctors educate their patients as
to the pros and cons, indications and contraindications, and risks
and benefits of vaccinations in order that the parents can then make
an informed choice for their children. By providing a balanced
view of the evidence on immunization, naturopathic physicians and
other health care providers can help people make intelligent
decisions regarding their health care, and the health care of their
In looking at infectious disease, there are several
factors involved in understanding the incidence of these diseases:
Individual emotional, mental, and physical states
The natural progression of the disease
By evaluating each individual case by these
parameters, one can then provide a framework to the parents from
which they can make their educated decision regarding immunization.
I want to emphasize this point. We as health
care providers to the public are obligated to give all the available
information regarding childhood infectious diseases and immunization
to our patients, but then we must let people make their own
decisions without our own personal bias or opinions. We then
must honor the parents' choice. If we do this, then we have
fulfilled our obligation as a doctor.
There are several other criteria which should be
evaluated before a decision is made:
What is the risk or probability of the child
getting the disease?
What are the health consequences of the natural
infection if contracted?
How safe is the vaccine that is available?
Is the immunity provided by the vaccine solid and
Will the vaccine stimulate the appropriate parts
of the immune system -- is the route of vaccine administration
compatible with the route of natural infection?
What is the child's health history and present
Are there alternatives to immunization, and if so,
are they safe and effective?
Active prevention involves routine immunization of
infants and children against diphtheria, tetanus, pertussis,
poliomyelitis (Types 1, 2, 3), measles, mumps, and rubella.
Any immunizing biologic should be used only in
conformity with published recommendations, as their effective use
requires reference to the latest guidelines established by
evaluation of both past and present knowledge. Two principal
groups publish such updated recommendations:
The Committee on Infectious Diseases of the
Academy of Pediatrics reviews and revises its "Report of the
Committee on Infectious Diseases" (The Red Book) every 3 years,
The Advisory Committee on Immunization Practices
(ACIP) of the U.S. Public Health Service publishes its
recommendations in Morbidity & Mortality, A Weekly Report (MMWR).
All manufacturers' warnings and recommendations
should be followed as well.
Some of the risks and contraindications to
Routine immunization should be deferred during
acute febrile illness
Atopic dermatitis or acute skin rash
Hypersensitivity to any vaccine component
Cases where the patient is undergoing
Cases where the patient has an altered immunity
(NaturoDoc comment: The immune systems of
newborns and infants under 6 months of age are undeveloped and are
therefore "altered." Immunization is thus contraindicated
until a child is old enough to have a viable immune system, which
can be from 18 to 30 months. )
The basic idea behind immunization is to produce a
state of immunity to these childhood infectious diseases through the
deliberate, artificial stimulation of the body's defenses against
each disease. Ideally, this is done without causing any
symptoms or signs of illness.
In reality, no immunizing biological agent is
completely safe, and it may produce side effects. It is
important to assess each individual child and each individual
vaccine, and then allow the parent to decide what to do after
weighing all the facts and sorting out the fiction.
Here is a brief look at each individual vaccination,
as taken from information from the Committee on Infectious Diseases
of the American Academy of Pediatrics.
Common Types of Vaccination
DPT (Diphtheria, Pertussis, Tetanus)
This is most commonly used in combination as a
trivalent mixture of diphtheria toxoid, tetanus toxoid, and
pertussis vaccine. It is also used as a bivalent mixture of
diphtheria toxoid and tetanus toxoid.
This is caused by Corynbacterium diphtheriae
and is a rare disease today, with less than 100 cases reported
annually in the U.S. Diphtheria toxoid for the vaccination is
prepared by formaldehyde detoxification of highly purified
diphtheria toxin. Children under 7 years of age receive 4
doses according to the adopted schedule. There are really no
contraindications unless one has a previous reaction to the agent.
There may be tenderness, edema, and erythema at the injection site
and a low-grade fever for a few days following the vaccine.
Passive immunity from the mother lasts about six months, and longer
in the breast-fed infant.
Pertussis (Whooping Cough)
This is caused by Bordatella pertussis, with
about 2,000 cases reported annually in the U.S. Pertussis
vaccine is a killed whole-cell preparation of a culture of
Bordatella pertussis. A series of four doses is given for
basic immunization, with a booster recommended between ages 4 and 6,
according to the adopted schedule. Newborns are susceptible in
spite of maternal immunity.
This vaccine is not recommended after age 6 due to
the increased risk of side effects. Contradictions include
neurological disorders of unknown status. Side effects include
screaming episodes and prolonged, unresponsive crying, fever of 105
or greater, convulsion with or without fever, collapse,
encephalopathy, and local inflammatory changes at the site of
Clostridium tetani produces a potent
neurotoxin, which, under anaerobic conditions, produces the disease
known as lockjaw. There are approximately 100 cases reported
annually in the U.S., with a 40% fatality rate. Immunity to
tetanus results from immunizing agents only; the disease does
not confer immunity. A newborn infant is immune if the mother
is properly immunized.
The tetanus toxoid is a formaldehyde-immunity, with
a reinforcing dose every 10 years. The only contraindication
is a severe prior reaction to the toxoid. There may be mild
inflammation at the site of injection.
There are about 20 cases of polio reported annually
in the U.S. Vaccines used according to the established
guidelines can be protective, with three separate doses given by age
2, and a booster given at about age 5.
Two types of polio vaccine are available in the
Oral polio vaccine (OPV), a live, attenuated virus
Inactivated polio vaccine (TOPV), a mixture of all
three types of the virus, which is recommended for those under age
Contraindications include immune deficiency
diseases, altered immune status, use of steroids, alkylating agents
and antemetabolites, and pregnancy.
MMR (measles, mumps, rubella)
This is often given as a trivalent vaccine at 15
months of age, although each one can be used separately.
The measles vaccine is a highly attenuated strain of
rubella virus. Duration of immunity is not known, although the
vaccine is good for at least 15 years. The disease itself, if
contracted, offers lifetime immunity. Vaccination is
recommended at age 15 months for all susceptible individuals.
Contraindications include acute febrile illness,
immunodeficiency diseases, pregnancy, malignancy, and use of
immunosuppressive drugs. Side effects of the vaccine include
moderate fever and skin rash.
The mumps vaccine is a preparation of a live
attenuated strain of mumps virus. Mumps is usually a
self-limited disease, and if contracted, offers lifetime immunity.
Duration of vaccine-induced immunity is unknown, but it does offer
protection for at least 12 years. Mumps rarely results in
permanent dysfunction, but can cause unilateral nerve deafness and
can cause mumps orchitis in postpubertal males. Maternal
antibodies protect up to about age 12 months.
Mumps vaccine is contraindicated in persons with
malignancy, immune deficiency disease, conditions of altered
immunity, and in pregnancy. Side effects to the vaccine are
usually limited to local mild inflammation at the site of injection.
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