She Who Could Not Be Wrong™ is going to be all over you for this. monkey fingered.

She won't come over here. I didn't write it as bait for her or anything. There are valid reasons to selectively vaccinate and I wanted that represented on OS. Not everyone who doesn't follow the AAP schedule to the letter is a vaccine conspiracy theorist, yk?

This is a great post. Informed and well researched.

Do you have the vitamin k at birth in America?

Yes, we do. My last baby was born at home with a midwife, so he didn't receive Vitamin K. I am planning to have a hospital birth with my next baby (if I conceive) and I am still debating Vit. K in the event of a non-traumatic birth. If there is a traumatic birth, I would always consent to Vit. K.

More about Vit. K- I am planning on using a CNM for our next birth. Vit. K is one of the things I'm planning on discussing with her beforehand (pros and cons) and I'll probably do whatever she recommends. I don't know enough about it to make a decision on my own, and I would probably just trust whatever my midwife had to say on the topic.

I appreciate this. I follow your same vaccination schedule except without the flu vaccine but with the chicken pox vaccine (I owned my own day care at the time I chose to vaccinate for chicken pox.) Fortunately, my children's doctor is supportive. Thanks for this informative post.

I am always amazed at the number of vaccines out there. As a kid, (born 1966), I had the Chicken Pox (which I guess now means I can get shingles - fun), and the Mumps and just recently, Whooping Cough! I did not know that your vaccines wear out and that as an adult you should get booster shots. Have I gotten my other booster shots? Heh, who has the time?

When I volunteered in the hospital, they had me get boosters to prevent the preemies from getting sick, but that was more than 10 years ago...

You know that and I know that, but She Who Could Not Be Wrong™ is an absolutest. Not doing what those gods (I mean doctors) told you to do makes you a Bad Mommy™. Only a Bad Mommy™ would think for herself like you do.

1: J Int Med Res. 2008 Nov-Dec;36(6):1255-60.
Decline in pneumonia and acute otitis media after the introduction of childhood pneumococcal vaccination in liguria, Italy.
Ansaldi F, Sticchi L, Durando P, Carloni R, Oreste P, Vercelli M, Crovari P, Icardi G.

Department of Health Sciences, University of Genoa, Italy.

The effect of the pneumococcal conjugate vaccine immunization programme on pneumococcal-associated or potentially pneumococcal-associated hospital admissions in the Italian region of Liguria was assessed. Hospital admission rates were compared in subjects belonging to birth cohorts before and after the introduction of widespread immunization for 0 - 2-year old children with a seven-valent conjugate vaccine (PCV7). Significant reductions in hospitalization rates for all-cause and pneumococcal pneumonia and for acute otitis media were observed in subjects born after widespread uptake of the vaccine. The preventive fraction (a measure of vaccine effectiveness) ranged from 15.2% for all cause pneumonia to 70.5% for pneumococcal pneumonia. This study contributes to the growing body of information that supports the beneficial effect of PCV7 vaccination.

PMID: 19094434 [PubMed - in process]

===============================

Early studies, _ca_ 2000, showed above to be true -- but the 'herd effect' had not taken hold. It is inevitable that when a niche opens up, there will be another organism which will exploit that space. Influenza type A may be ready to make this jump -- and H5N1 is the common one that we all look at to make the frontal breach of cross species jumps. Once you start breaking the 'herd effect' then you are endangering others -- about 3 years ago MMR had been rejected on a ridge about 30 miles from here. They closed the schools for two weeks as MMR made it around the J curve -- suddenly all three country health vans were standing room only in that rural area. While YOUR children may not be immuno-compromised -- what do you know about the person who is standing next to you -- or who washed their hands, and then was jostled to grab a public door handle, stair railing, etc --- sometimes things take awhile to begin to work -- so while 19F was still showing problems last year, (2007) but which were diminishing by the third shot, this year, there seems to be a building toward the threshold of a 'herd effect' --

You can think of it this way too -- which the forcing of a serotype into more and more niches -- it's like the Battle of the Bulge -- you let it in -- other sereotypes are being stopped, and then when you find a very effective 19F -- you cut it off, and destroy it through a herd effect -- but that still leave Flu A out there and H5N1 -- the real worry -- and what is the effect of PVC7 on that? We don't know yet -- perhaps it will bestow a bit of immunity through many of the similar membrane proteins.

perhaps -- but brushing off the immuno-compromised, and the aged, for studies where p's are in the p=.1xx and stating that your child is not likely to come into contact with hep B body fluids seems a bit callus and naive.

The chance that any of my kids is going to come into contact with hep b is outrageously small. I will wait until they are of age to be in a risk group. It's not naive at all. It's realistic. You can blow the chance of infection out of proportion for sensationalist purposes, but I've heard it all. You can't convince me that they are in a risk group so long as they are not having sex, they are not using IV drugs, they are not unvaccinated health care workers, and they are not sharing a household with anyone infected or in a high risk group. They do not need Factor VIII or any other blood products. If they are not in a risk group, they are not getting the vaccine. Period. When they reach 10-13, we'll re-evaluate and they'll get the series.

Sorry about my ignorance: isn´t vaccination mandatory and free in the States? Here in Argentina, every baby has a vaccination record, organized in dozes depending on its age, and these vaccines (the ones which are included in the national plan, chickenpox and many other included) are administered free of charge in any public hospital. In fact, one of the requisites for accepting children in kindergarten or as you call it day care is to have an updated vaccination plan... I feel very surprised!

Vaccines are "mandated", but you can get exemption forms.

About prevnar, desertriversky, are you saying that when the previous studies were conducted, herd immunity had not taken effect yet? And now herd immunity has taken affect with the prevnar and we are seeing a decrease in the number of invasive pneumococcal infections (total decrease, not just decrease in the vaccine serotypes)?

The last I heard they were looking at adding 6 more serotypes (for PCV13) to the vaccine to account for the decreased effectiveness. I was told that it was beneficial to the individual to get the vaccine, but detrimental to the herd as it was increasing serotype replacement and possibly contributing to scarier bugs.

OK! Thanks for the information, and thanks for the "mandated" term. I won´t forget. Thanks!

Holly, I spent some time in France, just as my kids were ready to start school. We were there for six months, so we enrolled them. It was astonishing to find that France only required four vaccines for school-age kids: Tetanus, Polio, Diptheria and Tuberculosis. And most doctors seem willing to sign an exemption for Tuberculosis, as the vaccine has questionable effectiveness and need.

France has an extremely high-quality system of health care. And they take antibiotics like candy. Why so few vaccines?

Hepatitis is endemic in Alaska and many rural states, so should be given early, as per the CDC guidelines.
Chicken pox is a serious illness for kids, even if they don't die. My kids still carry their scars on their faces. Pregnant women can get very sick and pass the disease on to their fetuses, with serious consequences. Again, the CDC has excellent question and answers re this.
You left out any discussion of HPV vaccines, which can reduce cervical, certain oral and anal cancers. And eliminate anxiety about abnormal pap smears and their expensive and worrisome work-up.

Choosing not to vaccinate or to vaccinate selectively is a religious decision, not a science based decision nor one made in the best interests of our children. I only hope they grow up to be smarter than we are.

I don't have any girls, so the HPV vaccine is a moot point for me to discuss. Personally I am over the age limit to get the vaccine for myself. In the event I have girls, I am sure I will have them vaccinated at puberty. In the event the vaccine is recommended for boys, I'm not going to have them vaccinated.

Less than 100 people die per year of chicken pox. Chicken pox is not a fatal illness in children who are not immuno-compromised. Pox marks are superficial and personally I know of no one who is disfigured by them as you describe. I'm not going to vaccinate my children for a disease which is not a threat to them before it is necessary.

I hear some of the critics saying that I should vaccinate my children for CP, Rota and Pneumococcal for the "herd immunity" benefit. I disagree. I have two people in this world I am responsible for- my kids. I am not responsible for other people's children. The health department gives vaccines for free to everyone regardless of socioeconomic status. If other people have immuno-compromised kids, they should make it a priority to 1) have them vaccinated, 2) implement hand-washing procedures and 3) keep them away from other children and crowds as much as possible. Every time my kids receive a vaccine, they are at risk for a vax reaction. The fatality rates for these diseases I don't vaccinate for are ridiculously small. It's a risk I'm willing to take to protect my children from any potential complications of the vaccines.

Let's look at it this way: (All of these numbers are based on an estimate of 5 million kids in the US under the age of 12. All case numbers are expected numbers based on actual case reports. All of this information can be found in the Dr. Sears book "The Vaccine Book", Chapter 14, Vaccine Safety Research.)

Chicken Pox- 200 serious cases expected over 1st 12 years. That's a disease risk (serious) of 1 in 25,000.

Hepatitis B- 130 expected cases, disease risk 1 in 40,000

And then, the risk of one child having a severe vax reaction over the entire series, 12 years, is 1 in 2600.

It's not worth it to vax my kids for hep b or cp. Every vax given is a risk for a reaction. If I can limit the number of vaccines, I can limit the risk of reaction.

If rota were proven to be safe, (in other words, if it had been on the market longer) it would be worth it to give rota (serious disease risk 1 in 100). If Prevnar were shown to not be experiencing serotype replacement, it would be worth it to give prevnar (serious disease risk 1 in 500). But the numbers don't add up for hep b or CP under the age of 12. And hep a? Hep a isn't even serious in kids. For adults, the disease risk is 1 in 25,000. So this disease doesn't even apply to my children.

Holly, thanks for an insightful and well-researched alternative viewpoint on vaccinating. I don't know a lot about PCV (or vaccines in general), but wouldn't vaccinating your kids protect them against more strains than letting them contract the disease? I understand how vaccinating leads to emergent strains, but which is worse: fewer people with more virulent strains, or more people with the garden variety? Seems like a tough call.

Alaska doc: Come on now, do you really think "religious" is an accurate adjective for what holly has written? I admire her critical thinking - if only more health care consumers did so.

Holly, very good and well researched post. I'm ambivalent about CP myself, having never had it myself! But I agree with your reasoning for holding off on Hep vaccines. Clearly you are not reactionary (religious? huh?) but instead well informed.
One question, you mention a non-thimerosal vaccine. Forgive my ignorance but hasn't thimerosal been removed from vaccines in the US?

Contaminated dried blood left for two weeks on a surface can cause seroconversion for Hep-b if I remember right. Just make sure you don't forget to get them vaccinated before they are too old.