(Excerpted from Dr. Bob Sears’ upcoming work, The Autism Book: Diagnosis, Treatment, Recovery, and Prevention coming in April 2010 from Little, Brown.)
With the alarming rise in autism over the last 15 years, parents and doctors continue to search for causes and contributing factors. Is it genetics? Environment? Toxic exposures? Infectious agents? Prenatal factors? A mix of various causes? At (or near) the top of the list of suspects in the minds of many parents are vaccines. Mainstream science and research continue to show there is probably no connection. Yet, some vaccine research in the world of alternative medicine (but not accepted as legitimate by the mainstream medical community) shows some possible connections to autism. So who are parents to believe? What are parents supposed to do when the CDC, AAP and virtually every doctor and academic medical institution in the country says, “You have nothing to worry about – continue to vaccinate according to the regular schedule,” but a friend, neighbor, or alternatively-minded doctor says “Wait – my child (or patient) regressed into autism 3 weeks after the one-year shots – don’t do it!” What do you do when you hear that story over and over and over again?
As a pediatrician and DAN! doctor, I’ve wrestled with this decision in my practice. Much of my day is spent as a general pediatrician, doing checkups, seeing sick kids, and, yes, giving vaccinations. Part-time I treat kids with autism using the DAN! protocol. So I see all kinds of families with many different views on vaccines.
I’ve had several patients develop autism without ever having any vaccines at all, but of course most of my patients with autism were vaccinated. I do believe vaccines are important, some more than others. The diseases do pose a risk, and in my opinion vaccines do help prevent these diseases. I know that’s a bold statement to make on an autism website. Many anti-vaccine advocates feel that vaccines are dangerous and don’t even work. But that hasn’t been my experience, nor is it my understanding based on all available research. However, vaccines do have side effects, and there is a small chance of serious, even life-threatening, reactions. Such events are well documented. But most kids seem to handle vaccine very well. Overall, the medical community feels that the disease protection benefit, both for the individual and for society as a whole, outweighs the risk of side effects.
But here is where families already affected by autism come into play. Does a child with autism have a greater risk of suffering a vaccine reaction (or as some parents would say, another vaccine reaction) if he continues to get more vaccines? And what about any younger siblings that come along? Should the parents vaccinate their next baby(ies)? That’s the bigger question. Is there a point where, for certain families, the risk of vaccines could outweigh the benefits of disease protection for that particular family? It would be nice if we could screen newborns for genetic and metabolic susceptibilities to severe vaccine reactions. We could then vaccinate such babies more carefully and find ways to avoid these reactions. But we don’t have that technology yet. So what is a family with autism to do? If they don’t vaccinate their subsequent children, does that put their child, and society as a whole, at risk?
I believe that for a child already affected by autism, the risk of continuing to vaccinate isn’t worth the disease protection gained. For any mainstream pro-vaccine person reading this, you are probably not happy to hear me make that statement. But I feel that the chemicals and immune-modulating properties of vaccines may cause further neurological, inflammatory, or autoimmune changes within that child (who already is dealing with such issues) and possibly make the autism worse. Now, do I have any science to back up my statement? Not directly, no. To my knowledge, no one has ever taken a group of a few hundred children with autism, given them their 4 to 6 year vaccines and yearly flu shots, and studied what happens to them compared to a group of kids with autism who don’t continue to vaccinate. Until that study is done, or some mainstream research comes out that demonstrates a possible link between autism and vaccines in the first place, we can’t answer this question with certainty. But we can take a logical and theoretical guess. In my opinion it’s possible that a child with autism would be genetically, immunologically, and neurologically more susceptible to vaccine side effects. Therefore I feel it is a perfectly legitimate choice for a family to decide not to continue to vaccinate their child with autism at this time until we know more.
I will say, however, that a family who decides not to continue vaccinations should have a very clear understanding of the disease risks they are taking. Although the risk of catching a severe case of what should be a vaccine-preventable disease is low for a child past two years of age, there is a risk nonetheless. Parents should educate themselves about that risk, and the risk to society if too many people make the same decision not to vaccinate. What is the risk to society by not vaccinating? Studies have shown that we need between 90 to 95% vaccine coverage in our society to be able to keep diseases under manageable control and prevent widespread outbreaks. Small outbreaks will occur, both in vaccinated and unvaccinated people (mostly in unvaccinated though, in my opinion), but as long as most of the surrounding population is vaccinated, these outbreaks can be contained. Since autism affects about 1 in 150 kids, if all of those families stopped vaccinating their affected child, as well as their subsequent children, this would only increase the unvaccinated population by about 1 to 2%. I don’t think that’s enough to tip the scales to allow widespread disease. Yes, it increases disease risks for those individuals, but not society as a whole to a significant extent. As long as the rest of society continues to vaccinate, that is.
Let’s take a look at the disease risk a child with autism would be taking if he didn’t get his 5-year booster shots or his yearly flu shot:
• Diphtheria (a severe respiratory infection) doesn’t exist in the U.S., except for the occasional case (or five) each year. This can be a risk with international travel, however, but not really with vacation travel – you’d have to be mingling with the local population to catch it.
• Tetanus occurs from deep, dirty wounds. Fortunately it is very rare in children (partly due to vaccine coverage and partly because children just aren’t as susceptible to having tetanus grow in their wounds). Despite all the tens of thousands of unvaccinated kids running around out there, we only see about 5 cases of tetanus in kids under 12 each year.
• Pertussis is a coughing illness that tragically kills about 20 infants each year. We don’t see fatalities beyond 6 months of age, so for an older child at five years, the shot isn’t important for him as an individual. The main reason to vaccinate an older child is to prevent spread of the disease through him to an infant sibling.
Polio vaccine: Polio doesn’t exist in the U.S., or the entire western hemisphere. So going unvaccinated in this country doesn’t pose any risk to that individual. Of course, it’s an important shot for most people overall so we can keep polio out.
• Measles causes several days of fever, aches, rash, and coughing, and most kids will work through the illness without any trouble. However, there can be complications such as pneumonia (occurring in about 1 in 100 cases), or the more severe encephalitis (infection within the brain), which occurs in about 1 in 1000 cases. The fatality rate from measles is about 1 in 2000 cases. For the past 15 years we’ve managed to keep measles to a minimum level in the U.S. – about 50 to 100 cases per year. This year (2008) we are looking at a slight increase to about 150 cases occurring in about a dozen cities. A five year old with autism would already have received one dose of the MMR vaccine at age 1; most of those kids will still have this immunity from measles, mumps and rubella until the teenage years, and therefore wouldn’t necessarily need a booster at 5 (this can be checked with a blood test). Those that have lost their immunity, but don’t get a booster, would have a risk of being caught up in a measles outbreak in their community and being responsible for spreading the disease if they caught it, but this risk is fairly small at this time. This could change if measles becomes more common.
• Mumps causes swollen tonsils and facial glands, fever, and rash, and most kids get through it without any trouble. Fatalities are virtually unheard of. We only see about 250 to 500 cases of mumps in the U.S. each year (except for an outbreak of about 5000 cases in 2006). So the chances that an unvaccinated child would catch mumps is fairly rare, but if he did catch it, virtually all childhood cases are harmless. In teens and adults, mumps can causes sterility.
• Rubella is harmless to any child or adult who catches it (mild fever, rash and body aches), but if a pregnant mom catches rubella it can cause birth defects. Because of vaccination, rubella is extremely rare – only about 10 cases are identified each year in the U.S. So, it would be safe for an older child to go without a rubella booster, since the disease would be harmless to him (keeping in mind, the very small risk to any pregnant parents or teachers around him).
This is given at age one, and most kids will retain that immunity throughout childhood (this can be verified with a blood test). Some will lose immunity, however, so a booster is offered at 5. Kids who don’t get a booster could be susceptible to the disease, although they’d likely catch a milder case because of their vaccine protection. The fatality rate from this disease is very low – about 1 in 65,000 cases. We do tragically see about 5 deaths each year in the U.S.
Flu vaccine is now recommended for every child up through age 18 at the start of every flu season (November). The flu tragically kills about 100 children every year. Fortunately, the vast majority of kids who catch the flu get through without any lasting harm. Getting a flu shot doesn’t prevent a child from catching the flu 100%, but it can help lower the chances. The main reason not to get a flu shot for a child with autism is that most brands contain mercury. Companies do make a small supply of mercury-free flu shots every year, so if a family was to choose to have their child get a flu shot, at least make sure it’s mercury-free. I know that most mainstream science has failed to show a link between vaccine mercury and autism, but for a child already with autism I believe that avoiding mercury is a good precaution anyway.
So, as you can see, the risk of skipping the 5-year shots for a child with autism is fairly low. Yes, it does leave a child open to some diseases, but the complication and fatality rates of anything he’d be likely to catch is fairly low. Skipping vaccines does pose some public health risk, however. An unvaccinated child can be the start of, or help spread, an outbreak of a disease. But considering the overall risk versus benefit of vaccines for a child with autism (and the neurological, auto-immune and inflammatory problems that may go along with autism), I don’t blame any parent for skipping the 5-year shots and the yearly flu shot.
In 20 states, vaccines are optional. Parents can waive them without providing a reason. But in 30 states, parents either have to have a religious reason or a medical waiver. Most DAN! doctors would likely provide a medical exception for any child with autism. But some parents without a DAN! doctor might find themselves in a bind. You could try getting religious really quick, but that wouldn’t be honest. You could also try to fight the system. I would think that many schools would be lenient on you, since you and your child already have so much to deal with. If you are forced into vaccinating anyway, you could first get a blood test to check the immunity levels from the infant vaccines. If your child still has immunity, most states will accept that in place of a booster shot. If you ultimately don’t have any choice and have to do the 5-year booster shots, I would suggest at least getting only one shot at a time and spreading it all out over a year or two.
VACCINATING SUBSEQUENT CHILDREN
What should parents do with the next baby that comes along? We do know that siblings have a higher risk of autism than the general population, but we really don’t know whether or not vaccines would increase that risk. I understand that many such families will take any and all possible precautions to prevent autism in their next children, including early diet restrictions, supplementation with probiotics, fish oil, and vitamins, limiting (or avoiding completely) antibiotics, and early intervention for any developmental delays. But what about vaccines? There is no clear answer. Some parents feel very strongly that vaccines played a role in their child’s autism, and would never vaccinate another baby. Some parents don’t feel the same way. I’m not going to say what the right decision is, because I don’t know. Yes, vaccines are important for disease prevention, but I can totally understand that any family that believes vaccines harmed their first child would view the vaccine risks as greater than the disease risks for their next baby. As you consider what the disease risks would be for a subsequent baby or babies, it becomes clear that some vaccines are more important than others, and parents who do decide to vaccinate their subsequent baby could pick and choose only certain vaccines. Here are some basic ideas about the various vaccines:
Hep B vaccine: I will be right up front and say that this is a really stupid vaccine for newborns (unless mom or dad is a Hep B carrier). There’s no realistic way for a baby or young child to catch this disease. So, this is a no-brainer – your baby doesn’t need this shot (at least in the first few years).
DTaP vaccine: Although U.S. babies don’t need tetanus or diphtheria protection, pertussis is a risk for babies in the first 6 months of life – we see about 20 babies die each year from it.
Pc vaccine: This vaccine protects against infant and toddler meningitis, bloodstream infections, and pneumonia. There are approximately 1000 such cases each year in the U.S., although the exact number of actual fatalities isn’t known.
HIB vaccine: This protects against a very rare form of infant and toddler meningitis. There used to be about 20,000 cases each year in the U.S. during the 1980s and before – now we see only about 25 (due, in my opinion, to the vaccine).
Rotavirus vaccine: This oral liquid vaccine protects against this vomiting and diarrhea intestinal illness. This infection kills about 50 babies each year, and hospitalizes about 50,000. It is very common.
Hep A: This food poisoning illness usually gets transmitted at restaurants. It’s a very mild disease in children. Teens and adults will suffer the worst stomach flu of their lives for a week or two. This is not a fatal disease, however, and it doesn’t cause long-term complications.
HPV vaccine: This is a 3-dose teenage vaccine (for girls only) to prevent the virus that causes genital warts and cervical cancer. Parents would need to determine if their older daughter is at risk.
Meningococcal vaccine: This teenage meningitis vaccine (one-dose only) protects against the type of meningitis that goes around high schools and colleges. There are about 3000 yearly cases with about 300 fatalities.
Polio, MMR, Chickenpox, Flu – see above.
This was a very basic look at each disease and vaccine. Parents should fully educate themselves as they decide what to do.
HOW TO CAREFULLY VACCINATE
In The Vaccine Book, I detail how parents who choose to vaccinate can do so in the safest manner possible by following these suggestions:
• Limit the number of vaccines to 2 per visit (instead of as many as 6 that are offered at each baby checkup).
• Delay certain vaccines that are designed to protect against a disease that a baby has no risk of catching in the U.S.
• Begin with the most important vaccines first, to protect a baby from the riskiest diseases.
• Understand about the various chemicals that are in vaccines and don’t overlap too many chemicals all at once.
• Avoid vaccines during times of illness, intestinal problems, and severe allergic conditions.
• Watch carefully for vaccine reactions and consider not repeating a vaccine that a baby has a moderate to severe reaction to.
The decision on whether or not to vaccinate is a difficult one for parents to make when autism runs in the family. For parents who decide to fully vaccinate their babies, my Alternative Vaccine Schedule (see The Vaccine Book for details) offers a way to vaccinate that avoids overloading with too many vaccines at a time and spreads them out over more years. For parents who want to be more selective in what vaccines they give their baby, and want to only provide the most important vaccines for the most serious diseases at an age when the diseases pose the most risk, I would suggest considering my Selective Vaccine Schedule:
2 months – DTaP, Rotavirus
3 months – Pc, HIB
4 months – DTaP, Rotavirus
5 months – Pc, HIB
6 months – DTaP, Rotavirus
7 months – Pc, HIB
15 months – Pc, HIB
7 years – Tetanus booster
I prefer the ActHIB brand of HIB, the Daptacel or Tripedia brand of DTaP, and any brand of Rota and Pc. This limits some of the chemicals that are in vaccines.
Parents can also choose to delay vaccines, although this leaves an infant open to some diseases. Once your child is 3 or 4 years of age and past the time when regressive autism would likely develop, you could then consider some vaccines. Which ones you would then choose isn’t an easy decision. You would take a look at each disease and decide if you feel that vaccine would be important for your child or for society around you.
Parents who decide not to vaccinate their infants should commit to prolonged breastfeeding (if possible), avoid group childcare, keep the baby out of church or health-club nurseries for the first two years of life, and promptly seek medical care if the baby develops a high fever, unusual rash, or bad cough. You don’t have to keep your baby quarantined. You can go about town, stores, and schools – as long as you aren’t leaving the baby in anyone else’s care with other infants around.
In conclusion, I would advise parents not to give a child with autism any further vaccines, as long as you feel comfortable with the disease risk. For subsequent babies, the decision is less clear. Parents have a choice to not vaccinate, restrict their vaccines to the Selective list in the first two years, or fully vaccinate. For sibling infants, I would recommend against the regular full vaccine schedule that groups as many as 6 vaccines together at each infant checkup. I think that overloads these susceptible babies with too many, too soon.
For more complete information on vaccines, visit www.TheVaccineBook.com
Robert W. Sears, MD, FAAP, is a board-certified pediatrician, DAN! doctor, and author in the Sears Parenting Library. He is a graduate of Georgetown University School of Medicine and Children’s Hospital Los Angeles.