Immunizations

By Eric S. Jones, ND

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 which ones.

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 dependents.

In looking at infectious disease, there are several factors involved in understanding the incidence of these diseases:

1. Sanitation

2. Nutrition

3. Individual emotional, mental, and physical states

4. Societal stressors

5. The natural progression of the disease

6. Natural immunity

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:

1. What is the risk or probability of the child getting the disease?

2. What are the health consequences of the natural infection if contracted?

3. How safe is the vaccine that is available?

4. Is the immunity provided by the vaccine solid and long-lasting?

5. Will the vaccine stimulate the appropriate parts of the immune system -- is the route of vaccine administration compatible with the route of natural infection?

6. What is the child's health history and present health status?

7. 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:

1. 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, and

2. 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 immunization are:

1. Routine immunization should be deferred during acute febrile illness

2. Atopic dermatitis or acute skin rash

3. Pregnancy

4. Hypersensitivity to any vaccine component

5. Cases where the patient is undergoing immunotherapy

6. 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.

Diptheria

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 injection.

Tetanus

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.

Poliomyelitis

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 U.S.:

1. Oral polio vaccine (OPV), a live, attenuated virus agent;  and

2. Inactivated polio vaccine (TOPV), a mixture of all three types of the virus, which is recommended for those under age 18.

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.

Measles (Rubeola)

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.

Mumps

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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