Alternative Vaccine Schedule Stirs Debate

Article in Journal Criticizes Popular Book on Timing of Kids' Vaccines

Medically Reviewed by Louise Chang, MD on December 26, 2008
From the WebMD Archives

Dec. 29, 2008 -- A popular book that presents an alternative vaccine schedule for infants and toddlers is flawed, misguided, and puts children at significant risk of preventable diseases, the journal Pediatrics reports in a harshly-worded article.

The Vaccine Book: Making the Right Decision for Your Child, by the widely-followed Robert Sears, MD, of Capistrano Beach, Calif., contains recommendations for vaccines that are at odds with those of the American Academy of Pediatrics and is dangerous, Paul Offit, MD, of the University of Pennsylvania's School of Medicine, tells WebMD.

The book also undermines recommendations by the CDC and the American Academy of Family Physicians, Offit says.

His analysis of the book is published in the latest edition of Pediatrics, the official journal of the American Academy of Pediatrics.

Sears' book, which has become a best seller and is popular among parents leery of vaccines, has induced many to change vaccine schedules or avoid recommended vaccinations for their children, Offit tells WebMD.

"What he does is, he capitalizes on the current culture's fear of vaccines by saying, 'not only do I understand your fear but I will provide you with a mechanism whereby you can act on that fear,'" Offit says. "His method is to separate, delay, or withhold some vaccines. That means some children become more susceptible for a longer time to diseases, and there is no reason to delay."

Alternative Vaccine Schedule: What Sears Says

Sears' book provides parents with alternative "schedules" for having children vaccinated to protect them from diseases once common in kids. For example, he proposes splitting up the measles-mumps-rubella vaccine, normally given all at once, into separate components spread over a few years, to keep from overloading children's immune systems. Although he writes that he has no research to show that giving the MMR and chickenpox vaccines at the same time is dangerous, he feels parents should have their children protected against the diseases gradually.

Sears tells WebMD that Offit and others have misunderstood his book, and that he believes in vaccines recommended by the American Academy of Pediatrics (AAP) and other medical organizations. He says he plans to write a rebuttal to Offit's article for submission to Pediatrics.

"I almost see myself as an ally of the AAP in that I'm finding ways to encourage parents who otherwise would not vaccinate [their children] to go ahead and vaccinate," Sears says. "I believe that my options will actually increase the vaccination rate. My book is admittedly not pro the AAP's vaccine schedule. My advice does differ in the way vaccines are given, but ultimately, I agree that vaccines should be given. For parents afraid of the way AAP says to do it, I give them an alternative."

He says "there is no science that is conclusive enough to show any links between vaccines and autism" but that his book provides "ways to vaccinate if you are worried about autism that may decrease the theoretical link if you believe there is such a link."

While numerous studies by the CDC, Institute of Medicine, and others have found no link between vaccines and autism, many people, including celebrities such as Jenny McCarthy, remain unconvinced.

Their case was bolstered earlier this year when a federal court ruled that a Georgia girl was entitled to compensation because she developed autism-like symptoms after receiving vaccines that aggravated a pre-existing condition.

These ongoing fears have had a tangible impact: A 2005 survey of vaccine-refusing parents published in the Archives of Pediatrics & Adolescent Medicine found that two-thirds of respondents said their main reason for rejecting vaccines was concern that they might be harmful.

The co-founders of a vaccine safety watchdog group, the National Vaccine Information Center, blame their children's learning disabilities and attention deficit disorder on reactions to the diphtheria, pertussis, and tetanus vaccine (DPT).

Impact of Vaccine Delay

Offit, who is a co-patent holder of Merck’s RotaTeq vaccine for rotavirus, says he understands why parents are concerned about the number of vaccines their children receive.

"Most recently, with the addition of several new vaccines to the infant schedule, some parents have become concerned that children receive too many vaccines too early," Offit says in the article. "Given that young infants currently receive 14 different vaccines, requiring as many as five shots at a single visit and 26 inoculations by 2 years of age, the concern that children might be overwhelmed by too many vaccines is understandable."

But there is no scientific validation to justify their fears, Offit tells WebMD.

Any delay of vaccines increases the likelihood that children will develop controllable diseases such as pneumococcus, pertussis, and chickenpox, Offit says, and the evidence that vaccines work is overwhelming. "If you withhold or separate or delay vaccines, those children suffer the consequences, and children suffer."

He says that that enforcement of vaccine mandates, which were initiated because of measles outbreaks that swept across the U.S. in the mid-1970s, has dramatically reduced hospitalizations and deaths resulting from vaccine-preventable diseases. He also says that states with philosophical exemptions to vaccines have higher rates of vaccine-preventable diseases (such as pertussis) compared with states without such exemptions.

He writes that "recent outbreaks of measles in 15 states" were caused by groups of concerned parents who fell prey to unjustified fears.

Offit writes that many parents are wary of accepted recommendations in part because they harbor "a suspicion of profit motive driven by pharmaceutical companies" as well as "misinformation on the Internet."

"It's very easy to scare people," Offit says. "It's very hard to unscare them."

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Paul Offit, MD, Vaccine Education Center, Children's Hospital of Philadelphia, department of pediatrics, School of Medicine, University of Pennsylvania.

Robert Sears, MD, author, The Vaccine Book: Making the Right Decision for Your Child.

Offit, P. Pediatrics.

WebMD Feature: "Children's Vaccines: Some Parents Ill at Ease."

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