Vaccine Debate by Jennifer Margulis
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Mothering Magazine issue 155 July -Aug 2009...
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This article was reprinted reprinted from Mothering Mothering magazine, magazine, issue ���, July–August ����. ©Mothering Magazine, Inc. ���� For more information, or to check out other available publications from Mothering Mothering,, visit our website: www.mothering.com
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G U O D
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by Jennifer Margulis
bate Many argue that unvaccinated children put others at risk. What does the evidence say?
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Just hours after my daughter
The desire for more information about the safety, efficacy, and even the necessity of vaccines has led to a growing number of parents choosing an alternative vaccination schedule for their children.
was bor n, in ����, at Atlanta’s Craword Long Hospital, a nurse bustled in with a metal tray. “ime or her hep B vaccine!” she announced in a chipper voice. I was �� years old. I had never questioned the efficacy or importance o vaccines, and was completely unaware that some people suspected there might be a link between autism and vaccines. As a child, I had received the ull round o recommended vaccinations. My mother is a microbiologist, my ather a chemist, and I grew up with a healthy respect or science and medicine. When, in my early twenties, I spent a year working in international development in West Arica, I updated my vaccination history and got shots or several exotic illnesses, ollowing to the letter the Centers or Disease Control’s ( CDC) schedule o recommended vaccines. But . . . vaccinate a newborn against a sexually transmitted disease? My husband and I had both tested negative or SDs, and had been in a monogamous relationship or three years. I looked at the tiny, perect baby in my arms, her legs still cocked in the etal position, whose entire lie now depended on me. We told the nurse that, beore we made a decision, we wanted more inormation about the disease and the recommended vaccination. Her eyes narrowed in anger and her entire demeanor toward us
Editor’s note: Due to the length of this article and the accompanying detailed references and citations, we have changed our usual style of endnotes for this ar ticle only.
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NOTES �. Until I began the research for this article, I didn’t know why the hepatitis B shot had been temporarily contraindicated for newborns. In Jul y ����, in response to public concern about thimerosal, the mercury-based preservative found in some
changed, as i we were creating a health threat merely by asking questions. A ew days later, during a routine visit to our pediatricia n, we asked what she thought o the hepatitis B shot, and explained somewhat guiltily that our daughter had not received it in the hospital. “Hepatitis B? Tat’s no longer recommended or newborns,” she replied matter-o-actly. “I have a ax about it on my desk. It’s a good thing you reused that vaccine.”� We lef conused, thinking how badly we would have elt had we agreed to vaccinate our daughter with a vaccine no longer recommended or newborns. We also wondered why the nurse in the hospital had been so hostile. As to why a newborn should be vaccinated against a sexually transmitted disease she had no chance o catching (unless she needed a blood transusion, which she didn’t), that question remained unanswered. Te desire or more inormation about the saety, efficacy, and even the necessity o vaccines has led to a growing number o parents choosing an alternative vaccination schedule or their children. Some now have their children vaccinated against only certain diseases, some spread out the shots over a longer schedule, and some choose not to vaccinate at all. Newborn in arms, I began to research, realizing that in order to be educated about vaccines, I
vaccines, the US Public Health Service and the American Academy of Pediatrics issued a joint statement requesting that thimerosal be removed from vaccines, and that the birth dose of hepatitis B be withheld from newborns whose mothers tested negative for hepatitis B. [See American Academy of
first needed to learn about the diseases they protected against. It quickly became clear that making these choices was not going to be eas y; my husband and I would need to learn about a nd consider each vaccine individually. In the years since my oldest daughter was born, the vaccine debate has been ueled by books and ar ticles that examine the link between autism and vaccines, and that give parents detailed inormation not included in the CDC -published handouts ound in every doctor’s office. Tese include David Kirby’s Evidence of Harm: Mercury in Vaccines and the Autism Epidemic—A Medical Controversy (St. Martin’s Press, ����), as well as more general books about vaccines—such as Dr. Stephanie Cave and Deborah Mitchell’s What Your Doctor May Not ell You About Children’s Vaccinations (Warner Books, ����), Aviva Jill Romm’s Vaccinations: A Toughtful Parent’s Guide (Healing Arts Press, ����), and, most recently, Dr. Robert W. Sears’s Te Vaccine Book: Making the Right Decision for Your Child (Little, Brown, ����). Celebrities such as actress and ormer Playboy model Jenny McCarthy, who believes her son was damaged by vaccines, and actor Jim Carrey, have brought attention to the vaccine issue, as have books by staunchly pro-vaccine advocates—such as Dr. Paul A. Offit’s Autism’s False Prophets: Bad Science , Risky Medicine, and the Search for a Cure (Columbia University Press, ����), which traces the history o the disease and concludes that there is no connection between autism and vaccines. Some vaccine advocates think the abundance o inormation now available, especially rom websites that ofen are neither edited nor peer-reviewed, is unortunate and ofen inaccurate. Tey argue that most parents are not trained scientists, and cannot effectively
Pediatrics, “Joint Statement of the American Academy of Pediatrics ( AAP ) and the United States Public Health Services ( USPHS),” Pediatrics ���, no. � (September ����): ���–���. See also Department of Health and Human Services, Centers for Disease Control and Prevention, “Notice to Readers:
Thime rosal i n Vaccines: A Joint Stateme nt of the American Academy of Pediatrics and the Public Health Service,” Morbidity and Mortality Weekly Report ��, no. �� (� July ����): ���–���.] Now that thimerosal has been removed from the hepatitis B vaccine, the CDC is again recommending
that all newborns receive it at birth, at � to � months, and again sometime between � and �� months, regardless of a baby’s risk f or contracting the disease.
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sif through what they read to get to the truth. Tese vaccine proponents—including Dr. Martin G. Myers, a proessor in the Department o Pediatrics at the University o exas Medical Branch at Galveston, ormer director o the Department o Health and Human Services’ National Vaccine Program Office, and coauthor with Diego Pineda o Do Vaccines Cause Tat?! A Guide for Evaluating Vaccine Safety Concerns (Immunizations or Public Health, ����)— argue that vaccines are undamentally sae. Tey believe that the risk o side effects has been grossly overreported by the media, and that this risk is negligible compared to the danger society will ace i vaccine-preventable diseases reinect the general population because large numbers But how great are o parents have stopped having their children the risks of the vaccinated. “I don’t know any rational person who could actual illnesses? truly be anti-vaccine, because the benefits are Some of the diseases so proound,” said Dr. Louis Cooper, Proessor that still appear on Emeritus o Pediatrics at the College o the schedule of Physicians and Surgeons o Columbia University, routine vaccinations and ormer president o the American Academy o Pediatrics (AAP), to a group o some �� are now so rare listeners at the Federal National Vaccine in the US that an Advisory Committee-sponsored community unvaccinated child meeting on vaccine saety in Ashland, has no quantifiable Oregon,� where approximately ��.� percent o risk of catching them, kindergartners had a religious exemption rom vaccination in the ����–���� school year, and and therefore no ��.� percent o kindergartners filed or religious quantifiable chance exemption or the ���� school year. �, � Vaccine of spreading them to advocates like Cooper argue that it has been other children. “proven” that there is no link between vaccines
�. Ashland Middle School, Ashland, OR (�� January ����). �. Jackson County Department of Health and Human Services pamphlet, Immunization: It Takes a Village to Protect a Child (����). �. “The ��.� percent Ashland kindergarten religious exemption statistic comes from data compiled by the Oregon Immunization Program, March ����. The Jackson County kindergarten religious exemption rate for ���� was �.� percent. The Ashland kindergarten
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and an epidemic o autism. (At the meeting, Cooper publicly dismissed as “crap” Dr. Andrew Wakefield’s ���� study,� which pointed out the act that vaccine-induced measles seems to occur in the intestines o autistic children and called or more research on the possible connection.) Tey also deny the possibility that vaccines may be partly responsible or the astronomical rise in recent years in the rates o autism, asthma, and other autoimmune diseases. � Tough, according to nationally renowned physician Dr. Robert W. Sears, to date no study o vaccine saety has used a control group o unvaccinated children large enough to be statistically significant,� the most outspoken proponents o vaccines find no flaws in the scientific studies that purport to show that vaccines are sa e, and label people who voice concerns about vaccine saety “misinormers” and “pseudoscientists.” � Vaccine advocates argue that parents who choose not to vaccinate create a serious health risk or everyone, and that their children are sae rom disease only because everyone around them is vaccinated. “When you have a pocket o children who are unvaccinated, that pocket is much more likely to support contagious diseases, like whooping cough or measles,” explains Dr. Offit, a pediatrician and chie o inectious diseases at Children’s Hospital o Philadelphia. � Citing a study in the Netherlands o a ����–���� measles outbreak among �,��� people, �� Offit argues that it’s not just unvaccinated children who are at risk or contagious disease: the study suggests that you are more likely to get a vaccine-preventable disease i you are
religious exemption rate from March ���� was ��.� percent, and the Jackson County rate was �.� percent.” Mothering communication with Lorraine Duncan, Oregon Immunization Program Manager, Public Health Division, Department of Human Resources (�� April ����). �. A. Wakefield et al., “Ileal-Lymphoid-Nodular Hyperplasia, Non-Specific Colitis, and Pervasive Developmental Disorder in Children,” Lancet ���, no. ���� (�� February ����): ���–���.
�. In March ����, the National Institutes of Health issued a ���-page report to Congress stating that autoimmune diseases, which include “more than �� chronic, and often disabling, illnesses that develop when underlying defects in the immune system lead the body to attack its own organs, tissues, and cells,” “collectively…affect ��.� to ��.� million people [in the US]. For reasons unknown, their prevalence is rising.” (National Institutes of Health, “Progress in Autoimmune Diseases Research”
A M Y E L L I O T T
I don’t know any rational person who could truly be anti-vaccine, because the benefits are so profound. � LOUIS COOPER, MD ully vaccinated and living in a generally unvaccinated community than i you are unvaccinated and living in a highly vaccinated community. Te assumption that unvaccinated children put others at risk has led to widespread criticism o vaccine-hesitant parents in the mainstream press. “People think you’re really selfish,” said JoNel Aleccia, a health writer or MSNBC .com who interviewed me.�� And it’s not only news media that criticize parents. In an episode o ABC ’s Private Practice that aired on January �, ����, an unvaccinated boy inected with measles in Switzerland creates a huge health scare in the doctor’s office, then dies. Te mother had chosen not to have him and his younger brother vaccinated because her oldest son had slipped
[March ����]: www.niaid.nih.gov/dait/pdf/ADCC_Final. pdf .) The CDC’s Autism and Developmental Disabilities Monitoring Network estimates that one in every ��� eightyear-olds in America has an autism spectrum disorder. (CDC, Autism Information Center, “Frequently Asked Questions—Prevalence,” www.cdc.gov/ncbddd/autism/ faq_prevalence.htm) According to the CDC, �.� million children currently suffer from asthma. (CDC, FastStats, “Asthma,” www.cdc.gov/nchs/FASTATS/asthma.htm)
into autism afer receiving vaccines. At the end o the episode, a doctor rom the practice orcibly vaccinates the mother’s youngest son. Tis episode o Private Practice was not only sanctioned by the AAP, it was created in close collaboration with them. According to an AAP newsletter sent out to members a month afer the show aired, �� several AAP members had helped craf the storyline. Attached to the newsletter is a letter rom AAP president Dr. David . ayloe, Jr. thanking Anne Sweeney, president o the Disney-ABC elevision Group, or ABC ’s thoughtul depiction o what can happen when children are not vaccinated: “Tis episode depicts the serious consequences that can occur when parents choose to skip or delay giving vaccines to their children or reasons
�. Personal communication with Dr. Robert W. Sears, MD (�� February ����). �. These are terms that Martin G. Myers and Diego Pineda use throughout their book, Do Vaccines Cause That?! See, for example, Chapter �, “Misinformation and the Return of Infectious Diseases” (Galveston, TX: Immunizations for Public Health, ����), ��–���. �. This and subsequent quotations: personal communication (� February ����).
Above: Dr. Louis Cooper, photographed in his home in New York City
��. S. van den Hof et al., “Measles Epidemic in the Netherlands, ����–����” Journal of Infectious Diseases ���, no. �� (�� November ����): ����–����. ��. JoNel Aleccia, “Vaccine-Wary Parents Spark Public Health Worry: More Opt Out for Fear of Reactions, But Do They Endanger Everybody Else?,” MSNBC (�� August ����): www.msnbc.msn.com/id/��������/ . ��. “AAP Assists in Pro-Immunization Story Line on ‘Private Practice’ ” AAP News OnCall �, no. � (February ����). July–August 2009
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Y L A E H S I L L O H
When you have a pocket of children who are unvaccinated, that pocket is much more likely to support contagious diseases, like whooping cough or measles. �PAUL OFFIT, MD
Above: Dr. Paul Offit, in his office in Philadelphia
that are not based upon best medical evidence. It also attempts to present some parents’ ear o vaccines as just that—ear—and not act. Many young parents today do not appreciate the danger o vaccine-preventable childhood diseases because they have never seen them firsthand. Tis Private Practice episode illustrates the reality o one such disease at its worst, and shows the regret that can accompany a decision not to vaccinate.” Te implications are clear: Not vaccinating is based on uninormed decisions and puts the entire society at risk, and parents who choose not to vaccinate their children should expect them to die. “I consider vaccinations a moral obligation to one another in society,” said one caller to an Oregon Public Broadcasting call-in show about vaccines on which I was being interviewed about our amily’s choices. Identiying hersel as a physician and a parent, the caller continued, “Tose who choose not to vaccinate rely on the rest o society to prevent epidemics o polio and measles rom ravaging our communities.”�� But Aviva Jill Romm, MD, author o Vaccinations: A Toughtful Parent’s Guide, who spent �� years in alternative medicine beore completing a medical degree at Yale University, objects to the idea that parents who choose not to vaccinate are ignorant and irresponsible. “Pediatricians need to let go o this knee-jerk reaction that parents who don’t vaccinate are irresponsible,” Romm contends. “Many o the parents I know who have chosen not to vaccinate are actually airly well-educated, actively contributing members o society. Tey are physicians, educators, people involved in government, law proessors, medical proessors, and academic proessors.”�� Dr. Robert W. Sears, MD, the son o attachmentparenting proponents William and Martha Sears and
��. Oregon Public Broadcasting, Think Out Loud , “Taking Shots,” hosted by Emily Harris (� January ����): http://stream�.opb.org/media/tol/ episodes/����/����.mp�. The show and some comments are po sted at www.opb.org/thinkoutloud/shows/taking-shots/ . ��. This and subsequent quot ations: personal communication (�� January ����).
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author o Te Vaccine Book, agrees. In Sears’s practice in Orange County, Caliornia, �� percent o his �,��� patients are not vaccinated at all, about �� percent are partially vaccinated, and about hal are vaccinated according to CDC guidelines. “It’s most ofen parents with a higher level o education choosing not to vaccinate,” Sears reports, adding that this is not because these parents are smarter, but because they are more likely to question and research everything having to do with their children. Sears, who describes himsel as “pro vaccine but willing to offer alternative schedules that parents eel more comortable with,” thinks the pro vaccine movement is doing parents a disservice by categorically dismissing their ears about vaccine saety and labeling parents who don’t vaccinate as negligent or selfish. “I think that any doctor who tells a patient ‘You have absolutely nothing to worry about, there’s no chance o a severe reaction’ is making a alse statement,” Sears says. “A better way to put it is, ‘Vaccines are very important, diseases can be severe, and I’d say the benefits o the vaccines outweigh the risks, but you need to be aware that there is a very small risk o a severe vaccine reaction.’”�� According to Sears, parents in his practice choose not to vaccinate because they would rather take the natural risk
��. This and subsequent quotations: personal communication (�� February ����).
that their child may catch an inectious illness than the perhaps small risk posed by vaccines. Tese parents decide that they do not want to intramuscularly inject their child with something that is artificial—i.e., not part o the natural course o lie. “It’s not a natural exposure to the disease,” Sears explains, stressing that though he does not agree with this point o view, he understands it. “It’s chemicals, it’s artificial. And by giving it to their child, they are taking a risk. Even though it’s a smaller risk than the disease risk itsel, these parents are less comortable with that kind o artificial risk.” But how great are the risks o the actual illnesses? Some o the diseases that still appear on the schedule o routine vaccinations are now so rare in the US that an unvaccinated child has no quantifiable risk o catching them, and thereore no quantifiable chance o spreading them to other children. A good example o this is polio. In the ����s and ����s, polio caused a serious health epidemic;�� since then, however, wild polio has been eradicated in the US. In act, polio became so rare here that even the most staunch proponents o vaccines admit that there was a greater risk o contracting and being paralyzed by polio rom the vaccine (which used to be a live virus administered orally) than contracting the naturally occurring disease itsel. �� For several years there
Te parents I know who have chosen not to vaccinate are actually fairly well-educated, actively contributing members of society. Tey are physicians, educators, people involved in government, law professors, medical professors, and academic professors. �AVIVA JILL ROMM, MD
��. Ibid.
��. Even before the development of the poli o vaccine, when the disease was widespread, most infected people were asymptomatic, and less than � percent of cases of poliovirus infection resulted in paralysis. See Note �: ��–��.
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In the absence of facts, doctors and others are trying to frighten people into vaccinating or not vaccinating. Tat fear includes the notions that unvaccinated children pose a great threat to others and that parents of these children are not being responsible. —JAY GORDON, MD
The CDC now recommends that children receive no fewer than �� injections against �� illnesses by the time they are �� years old—more than four times as many injections (including oral polio) as when I was growing up in the ����s.
��. Department of Health and Human Services, Centers for Disease Control and Prevention, “ Vaccines and Preventable Diseases: Polio Disease—Questions and Answers” (� April ����): www.cdc.gov/vaccines/vpdvac/polio/dis-faqs.htm. See also, Robert W. Sears, The Vaccine Book: Making the Right Decision for Your Child (New York: Little, Brown and Company, ����), ��. ��. Department of Health and Human Services,
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were zero inections o wild polio among US children; the vaccine itsel was paralyzing eight children a year. �� However, instead o discontinuing mass polio vaccinations—which were now clearly more dangerous than w ild polio itsel—an inactivated orm o the polio vaccine went into use. It is this vaccine that the CDC currently recommends to all American children at � months, � months, � to �� months, and � to � years—even though the last cases o naturally occurring polio in the US were in ����, and the last case o imported polio was more than �� years ago. �� In act, John Iskander, MD, MPH, Associate Director or Science at the CDC ’s Immunization Saety Office, tells me that polio is now so rare in the US that it is impossible to undertake a study to assess the risk an American child has o catching the disease. �� ranslation: An American child not vaccinated against polio poses no health risk to anyone. “When polio was a major health crisis, the quickest way to eliminate it was to vaccinate kids against polio,” says Dr. Howard Morningstar, who graduated rom Yale Medical School, completed his residency in amily medicine at Brown University, and has been working as a amily physician in Ashland, Oregon, or �� years. Morningstar reveals that most o his patients are not vaccinated according to CDC guidelines, “But there’s no polio
crisis now.” He is less concerned about possible side effects o vaccines than he is about the potential overall effect on the immune system o multiple vaccines. “I would rather use the long-term, triedand-true ways to prevent epidemics— sanitation, nutrition, hygiene, healthawareness—and save the emergency measures, like mass vaccinations, or true emergencies.”�� Like polio, diphtheria is a serious illness that once posed a quantifiable health threat in the US. It was so eared in the ��th and early ��th centuries that it was called “the strangling angel o children.”�� However, this severe throat inection, which is caused by a bacterium and is treatable with antibiotics and an antitoxin, now occurs so rarely that most doctors trained within the last �� years can’t recognize its symptoms. According to the CDC , there are approximately “�.��� cases per ���,��� population in the US since ����,” which translates into � case per ��� million people, a number that is barely measurable. �� An unvaccinated Pennsylvanian who had visited Haiti died o diphtheria in ����,�� but no American child has died o diphtheria in the US in at least �� years. �� “We do not have to worry about contracting diphtheria anymore,” admits John Iskander. �� Yet because the disease has not been eradicated worldwide, and because other countries, particularly
Centers for Disease Control and Prevention, “Vaccines and Preventable Diseases: Polio Disease—Questions and Answers” (� April ����): www.cdc.gov/vaccines/ vpd-vac/polio/dis-faqs.htm . ��. Personal communication (�� January ����). ��. This and subsequent quotations: personal communication (� February ����). ��. Cem S. Demirci, MD, and Walid Abuhammour, MD,
“Diphtheria,” eMedicine (updated �� July ����): http:// emedicine.medscape.com/article/������-overview . ��. Department of Health and Human Services, Centers for Disease Control and Prevention, “Diphtheria” (� October ����): www.cdc.gov/ncidod/ DBMD/diseaseinfo/diptheria_t.htm . ��. P. Lurie, et al., “Fatal Respiratory Diphtheria in a U.S. Traveler to Haiti—Pennsylvania, ����,” Morbidity
J A S O N D A I L E Y
It’s one of those topics where there is fundamental disagreement even about what counts as fact. �JOHN LANTOS, MD in Eastern Europe, sometimes see spikes in diphtheria inections, �� the vaccine continues to appear on the CDC ’s schedule o recommended vaccines and is given—in combination wit h the tetanus and pertussis vaccines—to children at ages � months, � months, � months, �� to �� months, and � to � years. However, as with polio, an American child who has not been vaccinated against diphtheria and does not travel abroad has no quantifiable chance o spreading the disease to another American child. Te same argument can be made about two other diseases on the schedule o routine childhood vaccinations: tetanus and hepatitis B. etanus is caused by a bacterium ound in t he
and Mortality Weekly Report ��, no. �� (� January ����): ����–����; www.cdc.gov/mmwr/preview/mmwrhtml/ mm����a�.htm. ��. According to Tejpratap Tiwari, MD, medical epidemiologist at the CDC, the last reported diphtheria death in a probable (not lab-confirmed) childhood case occurred in an unimmunized fouryear-old boy in ����. Prior to that, the last diphtheria
soil, on dirty, rusty metal, and on dirty needles. A child not vaccinated against tetanus, while at risk or contracting the disease himsel, poses no risk to anyone else. �� Hepatitis B is primarily transmitted through unprotected sex, the sharing o unclean needles, and rom an inected mother to her newborn. Unless a child sick with hepatitis B is exchanging blood or other body fluids w ith another person’s child, an u nvaccinated child has no chance o spreading the disease. Measles is one o the diseases requently invoked by vaccine proponents to illustrate the irresponsibility and selfishness o parents who choose to not have their children vaccinated.
death in a culture-confirmed childhood case occurred in an unimmunized nine-year-old female in ���� (e-mail communication, � April ����). ��. See Note ��. ��. Charles R. Vitek and Melinda Wharton, “Diphtheria in the Former Soviet Union: Reemergence of a Pandemic Disease,” Emerging Infectious Diseases �, no. � (October–December ����): ���–���; www.cdc.gov/
Above: Dr. John Lantos, shown here with his wife, Martha Montello, outside their home
ncidod/eid/vol�no�/adobe/vitek.pdf . ��. Given that tetanus is most commonly contracted by stepping on a rusty nail, some parents wonder why this vaccine would be given to children when they are two months old, and again when they are four months old, as at this age infants have no chance of getting the disease.
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R E H S I F E O L A R A B R A B F O
If the vaccines are effective, then those who get vaccinated should have nothing to fear from the unvaccinated. �BARBARA LOE FISHER
One study, published in the March ���� Pediatrics, suggests that children who get measles are less likely to have allergies.
Above: Barbara Loe Fisher, cofounder of the nonprofit National Vaccine Information Center and the mother of a vaccine-injured child
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Unlike polio, diphtheria, tetanus, and hepatitis B, measles is a viral inection that is highly contagious and easily spread. Between ����, when measles was declared to be eliminated rom the US, and ����, an average o �� cases o measles were reported annually. But rom January to July o ����, ��� cases o measles were reported to the CDC , sparking widespread concern among public health officials.�� “With the outbreaks o pertussis, measles, and now Haemophilus influenzae type b,” says Paul Offit, “we have reached a point where it’s clear that a choice not to get a vaccine can be harmul not only to your child but to the child who comes in contact with your child.” Yet the measles vaccine is thought to have a rate o effectiveness o close to �� to �� percent, �� and Offit readily admits that the very small percentage o vaccinated children who mig ht contract measles i exposed to it would have only a mild case o the disease, assuming they had some immune response to the vaccine. A child who ollows the recommended guidelines or the measles-mumps-rubella (MMR ) vaccine and is vaccinated against measles at between �� and �� months o age, and again between � and � years, should have a negligible risk o contracting the disease. Although the Private Practice episode depicted measles as a disease
that causes almost instant death, beore the MMR vaccine, measles was a routine, even ubiquitous, illness o childhood that rarely led to complications in otherwise healthy children. Some health-care providers and many parents who choose not to vaccinate believe that there may be long-term benefits to getting a disease like measles, including lielong immunity and a strengthening o the immune system overall. One study, published in the March ���� Pediatrics, even suggests that children who get measles are less likely to have allergies.�� But whatever your opinion about measles, we know that the vast majority o measles cases are mild, and we are told that a child vaccinated against measles will have an even milder case. Tere seems to be no real risk to vaccinated children rom unvaccinated children o being exposed to or o havi ng any complications rom this disease. “I the vaccines are effective, then those who get vaccinated should have nothing to ear rom the unvaccinated,” points out Barbara Loe Fisher, coounder o the nonprofit National Vaccine Inormation Center and the mother o a vaccineinjured child. “I the vaccines are not as effective as the companies, government, and pediatricians have told us, then what a person does when they get vaccinated is they take a high risk o having a vaccine reaction as well as a high risk o
��. “Update: Measles—United States, January–July ����,” Morbidity and Mortality Weekly Report ��, no. �� (�� August ����): www.cdc.gov/mmwr/preview/ mmwrhtml/mm����a�.htm. ��. W. Atkinson et al., eds., Epidemiology and Prevention of Vaccine-Preventable Diseases , ��th ed.
(Washington, DC: Public Health Foundation, ����), ���. ��. Helen Rosenlund et al., “Allergic Disease and Atopic Sensitization in Children in Relation to Measles Vaccination and Measles Infection,” Pediatrics ���, no. � (March ����): ���–���.
Y S E T R U O C
A S S O C I A T E D P R E S S
Te bottom line with pertussis is that it’s not a perfect vaccine. not having the vaccine work.”�� What about the idea that pockets o unvaccinated children can threaten the entire herd? Because the necessary scientific studies have not been done, it’s difficult to answer this question. I called Te Principia, a Christian Science school with two campuses, one or preschool to high school students and another or college students, in the St. Louis, Missouri, area. Christian Scientists have a wide range o belies, and the Church o Christ, Scientist, allows its members reedom o choice in vaccination and other types o health care; however, many Christian Scientists choose not to vaccinate their children because o their belie in the power o prayer to prevent and heal illness. O the �,��� students at Te Principia in ����, more than �� percent—���—filed vaccine exemptions. Despite the high numbers o unvaccinated children at the school, in the past ten years there have been
��. This and subsequent quotations: personal communication (�� January ����). ��. Personal communication, Laurel Walters, Communications Director, The Principia (April ����). ��. See Note ��: ��.
�JAMES SHAMES, MD
no outbreaks on either campus o measles or any other diseases preventable by legally mandated vaccines, and no deaths rom these diseases.�� Whooping cough, aka pertussis, is another highly contagious disease that worries publichealth officials, but unlike the measles vaccine, the pertussis vacci ne is only �� to �� percent effective.�� According to the CDC , there were approximately ��,��� cases o pertussis nationwide in ����,�� and ��,��� in ����.�� Most teenagers and adults who have whooping cough don’t know it—the disease is mild a nd annoying (the cough can l inger or up to three months), but usually not serious enough to warrant even a vi sit to the doctor. In inants, however, whooping cough can be lie-threatening. “Te bottom line with pertussis is that it’s not a perect vaccine,” explains James Shames, MD, the medical director o Health and Human Services or Oregon’s Jackson and
��. Department of Health and Human Services, Centers for Disease Control and Prevention, “Summary of Notifiable Diseases—United States, ����,” Morbidity and Mortality Weekly Report ��, no. �� (�� March ����): ��; www.cdc. gov/mmWR/PDF/wk/mm����.pdf .
Above: Dr. James Shames, medical director of Health and Human Services for Oregon’s Jackson and Josephine Counties
��. Ibid.
July–August 2009
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No matter what measures you take to boost your child’s natural immunity, there is no way to eliminate risk: there are risks to vaccinating, and risks to not vaccinating.
Because the studies of autism and vaccines do not include control groups of large enough numbers of completely unvaccinated children, it’s disingenuous of scientists and of the mainstream press to claim that the link between autism and vaccines has been disproved.
Josephine Counties, who believes the requency o the disease is underreported.�� Whooping cough is atal in � percent o the inants under the age o six months who contract it. Te CDC estimates that �� to �� people die o whooping cough each year out o a population o ���,���,���.��, �� Vaccine proponents worry that i everyone in Jackson County decided to reuse the pertussis vaccine (which is routinely given at � months, � months, � months, ��–�� months, and �–� years), it would affect the well-being o the county in general, and inants could die. Tis ear, however, is purely theoretical, and not based on any statistics. Ashland, which is in Jackson County, has one o the lowest rates o childhood vaccination in the US,�� but in the last ten years no child or adult in the county has died o whooping cough.�� I a child does catch a vaccine-preventable disease, is it really possible to trace with certainty where the disease came rom? For Jay Gordon, MD, a pediatrician with more than �� years o experience and an a ssistant proessor o pediatrics at the UCLA Medical School, the answer is no. “When chi ldren or babies who have been in contact wit h other chi ldren (or adults) contract most il lnesses, there is no easible way to know rom whom they got the disease,” Gordon writes in First Impressions, an online companion to the Michigan Law Review.�� “Whether one is talking about a routine winter viral illness, chicken pox, or whooping cough, the contag ion could have come rom a child with overt disease signs and symptoms, an asy mptomatic carrier, or
��. Personal communication (�� January ����). ��. Centers for Disease Control, “Pertussis (Whooping Cough)—What You Need to Know” (�� January ����): www.cdc.gov/features/pertussis// . ��. Central Intelligence Agency, “United States,” The World Factbook (updated � April ����): www.cia.gov/ library/publications/the-world-factbook/print/us.html . ��. See Notes � and �. For the ����–���� school year,
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July–August 2009
another, perhaps mutual, contact.” Gordon urther asserts that a parent who chooses not to vaccinate her own child is not accountable or responsible or another child contracting a vaccine-preventable disease. Instead, the burden o protecting an inant rom a contagious disease is on the inant’s parent, not on the parents who choose not to take the risk o injecting their child with a pharmaceutical product that is known to cause adverse reactions and is not always effective. “Parents must protect [inants too young to have received a ull complement o shots and immuno-compromised children] by keeping them away rom too many other children. Period,” Gordon writes. “Newborns and young babies are at risk any time they are in public. We can only vaccinate against a very small minority o contagious illnesses; it is unwise to bring your newborn into preschool when you pick up your toddler, and equally risky to attend older children’s birthday parties with this baby.” �� Public health officials point to the death o an unvaccinated baby in Minnesota in ���� as an example o how dangerous it is not to vaccinate. But o the five children who became inected with Haemophilus influenzae type b (Hib), a bacterial inection that can cause meningitis, pneumonia, and blood and bone inections, two had been vaccinated against Hib. ��, �� About a year beore, on December ��, ����, the pharmaceutical giant Merck & Co. had recalled more than � million doses o the Hib vaccine because equipment used in manuacturing it was ound to be inected with Bacillus cereus, a
�.� percent of incoming kindergartners in all states filed for philosophical exemption, �.� percent filed for medical exemption, and only �.� percent filed for religious exemption, according to information compiled by self-reported data from each state by the Department of Health and Human Services, Centers for Disease Control and Prevention and obtained via e-mail from the Centers for Disease Control and
Prevention, National Center for Immunization and Respiratory Diseases. ��. Carol Irwin, RN, Community Health Nurse, Jackson County Public Health, personal e-mail communication (� March ����). ��. Jay Gordon, MD, “Commentary: Parents Should Not Be Legally Liable for Refusing to Vaccinate Their Children,” Michigan Law Review ���, First
S T E P H A N I E G R O S S
As a nurse, I had just assumed that everything we had been asked to do was based on good, solid science. But the gaps in the science are, frankly, what we’re still dealing with now. �VICKY DEBOLD, RN, PHD bacterium associated with ood poisoning and diarrhea.�� Parents in Minnesota who had their children vaccinated against Hib beore the recall were unknowingly injecting their children’s bodies with a potentially contaminated product. For a vaccine proponent such as Paul Offit, who downplays the dangers o vaccines, the choice to vaccinate is the only one to make, and the death o even one child rom a vaccinepreventable disease is unacceptable. But or the hundreds o thousands o parents whose children have been dama ged by adverse reactions to vaccines, there is no way to quantiy which child’s lie is more important. “You cannot put a greater value on the lie o a child
Impressions (����): ��; www.michiganlawreview.org/ firstimpressions/vol���/gordon.pdf . ��. Ibid.: ��. ��. Department of Health and Human Services, Centers for Disease Control and Prevention, “Invasive Haemophilus influenzae Type B Disease in Five Young Children— Minnesota, ����,” Morbidity and Mortality Weekly Report �� (Early Release, �� January
who is injured or dies rom a disease than the lie o a child who is injured or dies rom a vaccine reaction,” says Barbara Loe Fisher. Vicky Debold, RN , who also has a PhD in Public Health, has had firsthand experience with inants who have died as a result o Hib inections. When she worked as a pediatric nurse in an ICU in the early ����s, she saw two inants die o Hib, and worked with the grieving parents. Partly because o that experience, Debold was a staunch proponent o vaccines, and thought that people who were skeptical o them were ignorant and misguided. But in August ���� when her own son was �� months old, ollowing a routine round o vaccinations,
����): �–�; www.cdc.gov/mmwr/preview/mmwrhtml/ mm��e����a�.htm. ��. One child had received two doses of t he Hib vaccine, in accordance with the CDC recommendations for a five-month-old, another child had received two doses of the Hib vaccine, but no booster shot, per CDC recommendations at the time. Given that vaccinated children far outnumber the
Above: Vicky Debold, at home with her son, Sam, 11, who was diagnosed with autism shortly after receiving a routine round of vaccinations
unvaccinated, the fact that three of the five children who were infected were u nvaccinated suggests that the unvaccinated are overrepresented among those getting sick. ��. Centers for Disease Control and Prevention, Vaccines & Immunizations, “Questions and Answers about Hib Recall” (�� December ����): www.cdc.gov/ vaccines/recs/recalls/hib-recall-faqs-��-��-��.htm. July–August 2009
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Merck & Co., which manufactures the MMR vaccine touted as
life-saving medicine in the Private Practice episode that AAP doctors helped write, donated to the AAP in the “����,��� to ����,���” category.
Given the enormous amounts of money to be made from manufacturing vaccines, parents wonder how health officials and even the AAP can be impartial.
��. This and subsequent quotations: personal communication (�� January ����). ��. Department of Health and Human Services, Centers for Disease Control and Prevention, “Recommended Immunization Schedule for Persons Aged � Through � Years—United States: ����”: www.cdc.gov/vaccines/recs/schedules/downloads/
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July–August 2009
he could no longer stand up in his crib, lost interest in walking, and started having bad diarrhea. “I just thought it was because his legs were sore,” Debold remembers. “But within a couple o months, I noticed that his speech had stalled out.” Beore he turned three, Sam was diagnosed with autism. �� Although Debold had once browbeaten her sister into getting her daughter vaccinated, she now believes that her own child was damaged by vaccines. “I think it’s really hard or people who have actually given vaccines to think something you did could have caused injury,” Debold explains. “Vaccines are something that I willingly participated in or my son. Te natural deense as a mother and a nurse is that I didn’t do anything wrong.” But the more Debold researched the issue, the more skeptical she became. When she went to the library to find articles that proved the efficacy and saety o simultaneously receiving multiple vaccinations, she was shocked to find almost none. “Te more I looked, the less I ound,” Debold says. “As a nurse, I had just assumed that everything we had been asked to do was based on good, solid science. But the gaps in the science are, rankly, what we’re still dealing with now.” Tese gaps in the research about vaccine saety remain a concern or parents. Te CDC now recommends
that children receive no ewer than �� injections against �� illnesses by the time they are �� years old ��, ��—more than our times as many injections (including oral polio) as when I was growing up in the ����s��—but there have been ew, i any, scientific studies comparing the health o vaccinated and unvaccinated children, �� and to date, no scientific studies o vaccine saety t hat include a statistically significant control group o children who have received no vaccinations at all.�� Dr. Robert W. Sears would like to see studies done with rom ��,��� to ���,��� unvaccinated children, but such studies do not exist. “In the absence o acts, doctors and others are trying to righten people into vaccinating or not vaccinating,” writes Dr. Jay Gordon. “Tat ear includes the notions that unvaccinated children pose a great threat to others and that parents o these children are not being responsible. In act, these parents are choosing what they consider to be the saest course o action or their children and pose very little, i any, danger to other children and adults.”�� Te bottom line is that t here’s still a lot we don’t know about vaccine sa ety and the long-term effects o vacci nes on the bo dy’s immune system. “It’s one o those topics where there is undamental d isagreement even about what counts as a act ,” declares John
child/����/��_�-�yrs_schedule_pr.pdf . ��. Department of Health and Human Services, Centers for Disease Control and Prevention, “Recommended Immunization Schedule for Persons Aged � Through �� Years—United States: ����”: www.cdc.gov/vaccines/recs/schedules/downloads/ child/����/��_�-��yrs_schedule_pr.pdf .
��. According to Barbara Loe Fisher, in the late ����s, most children received five DPT shots (�� doses of three vaccines) and five doses of Oral Polio Virus at �, �, �, and �� months of age, and between � and � years, plus one dose of MMR between �� and �� months. More information about vaccine licensure dates can be found at a website operated by the Immunization
J E N N I F E R M A R G U L I S
I would rather use the long-term, tried-and-true ways to prevent epidemics— sanitation, nutrition, hygiene, health-awareness—and save the emergency measures, like mass vaccinations, for true emergencies. � HOWARD MORNINGSTAR, MD Lantos, MD, a pediatrician and bioethicist at the University o Chicago and the Center or Practical Bioethics in Kansas City, Missouri.�� We don’t know i giv ing vaccines in combination with other vacci nes is sae. We don’t know i the a luminum and ormaldehyde ound in measurable quantities in some vaccines and injected intramuscularly into our bodies has negative health consequences. Because the studies o autism and vaccines do not include control groups o large enough numbers o completely u nvaccinated children, it’s disingenuous o scientists and o the mainstream press to claim that the
Action Coalition and funded by the CDC . www. immunize.org/timeline. See also Paul A. Offit, MD, and Louis M. Bell, MD, Vaccines: What You Should Know (Hoboken, NJ: J ohn Wiley & Sons, ����), ��. ��. Dr. Bernardine Healy, health editor of U.S. News & World Report and former director of the National Institutes of Health, signaled this fact on Larry
link between autism and vaccines has been disproved. When public health officials dismiss parental concerns without adequately studying them, there is an erosion o public trust. Given the enormous amounts o money to be made rom manuacturing vaccines, parents wonder how health officials and even the AAP can be impartial. In ����, the pharmaceutical firm Wyeth, which makes Prevnar, the only brand o the pneumococcal vaccine widely used in the US (the Pc vaccine is currently recommended or children ages �, �, �, and �� to �� months), was one o the AAP ’s top corporate donors, giving in the “����,��� and
King Live (� April ����): “I think there is so much more to learn. Simple things like a comparison o f children who have and have not been vaccinated. This is s omethi ng that we h ave talked about doing for many years. It has not b een done. It can be done through various models, through case control models. It can be done retrospectively.
Above: Dr. Howard Morningstar, photographed in his office in Ashland, Oregon
It has to be done.” http://transcripts.cnn.com/ TRANSCRIPTS/����/��/lkl.��.html . ��. Ibid. ��. See Note ��: ��. ��. Personal communication (�� January ����).
July–August 2009
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N R U B I P G U O D
Vaccines are very important, diseases can be severe, and I’d say the benefits of the vaccines outweigh the risks, but you need to be aware that there is a very small risk of a severe vaccine reaction. � DR. ROBERT W. SEARS, MD
Above: Dr. Robert W. Sears, near his home in Southern California
Above” category.�� Merck & Co., which manuactures the MMR vaccine touted as lie-saving medicine in the Private Practice episode that AAP doctors helped write, donated to the AAP in t he “����,��� to ����,���” category.�� Paul Offit, who wrote an article excoriating Dr. Robert W. Sears’s alternative schedule that was published in Pediatrics, the AAP ’s peer-reviewed journal,�� himsel has a clear financial conflict o interest: coinventor o the Rotaeq vaccine, he is also a coholder o the patent on it. �� “Merck isn’t dumb,” Dr. John E. rainer III, a amily physician in Jacksonville, Florida, wrote me in a n e-mail. Although rainer describes himsel as “very pro-vaccine,” he understands why parents have concerns: wo o his own our children have suffered vaccine-induced complications. “Tey aren’t doing this (solely) to be nice. And they are making enough money to hire a sales orce. Tey visit us and other docs to try to sell more vaccines.”�� In the last three years, three new Merck vaccines have been approved by the ederal government or sale: Rotaeq, Zostavax, and Gardasil. “What does it mean to orce everybody to be vaccinated?” asks Dr. Howard Morningstar. “It’s a philosophical decision—it’s not based on rational scientific acts.” Afer reading everything we could about vaccines, calling the CDC , and talking to dozens o people in the health-care proessions and other parents (most o whom had chosen to vaccinate), my husband and I chose not to vaccinate our children against hepatitis B or any o the other childhood illnesses. Making our choices vaccine by vaccine, we agonized over whether each was the right choice. We also did everything we could to help our children have healthy immune systems to fight any diseases their bodies might be exposed to.
��. American Academy of Pediatrics, “Honor Roll of Giving,” AAP News ��, no. �� (November ����): ��. ��. Ibid. ��. Paul A. Offit and Charlotte A. Moser, “The Problem with Dr. Bob’s Alternative Vaccine Schedule,” Pediatrics ���, no.�
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July–August 2009
(January ����): e���–e���; http://pediatrics. aappublications.org/cgi/content/full/���/�/ e���. ��. Ibid. ��. Personal communication (�� January ����).
I breasted them well past two years, and we educated ourselves about good nutrition and changed our eating habits. We also gave away all o the poisonous cleaning products in our house, began buying organically grown oods, and made sure our children got enough exercise, sleep, and outdoor time. Ten, in ����, when the children were six, our, and two years old, I was awarded a Fulbright ellowship to teach and do research in Niger, West Arica, one o the poorest countries in the world, where diseases—including typhoid ever, malaria, measles, schistosomiasis, meningitis, g iardiasis, dengue ever, and hepatitis—are common. A yellow-ever vaccine is required or entry into the country. Afer revisiting every childhood illness and assessing the health risk s posed by international travel, we decided to vaccinate our children against only three other diseases, besides yellow ever: polio, tetanus, and meningitis. We used the German-made tetanus-only vaccine instead o a DP combination, and spaced out the shots, one at a time, over a period o several months, so that i our children had a bad reaction, we would know which vaccine it was. No matter what measures you take to boost
your child’s natural immunity, there is no way to eliminate risk: there are risks to vaccinating, and risks to not vaccinating. It is counterproductive to terriy parents into vaccinating their children, or to viliy those who choose not to. In the US, we have the right to reuse a pharmaceutical product, and it doesn’t surprise me that more parents than ever are exercising that right. Te CDC , the drug manuacturers, government spokespeople, vaccine advocates, and vaccine skeptics—most o those who make up each o these groups are also parents. As parents, we all have a common goal: to keep our children and our nation as healthy as possible.
As parents, we all have a common goal: to keep our children and our nation as healthy as possible.
Interested in finding out more about the vaccine controversy? Log on to www.mothering. com/links or access to our entire section on vaccines, including t he past article, “Chickenpox Party” by Brian Wimer, Jacquelyn L. Emm, and Deren Bader; the Vaccinations orum on our discussion boards; the “Vaccines: Mercury, Autism & Chronic Disease” reprint (available or purchase); and a special video o Vicky Debold’s son, Sam, playing piano.
Jennifer Margulis, PhD, is a professional writer and the mother of three (�, �, and �). She lives in Ashland, Oregon, and was a Fulbright Scholar in Niger from ���� to ����. Read more about her at www.jenniermargulis.net.
July–August 2009
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v a r i v a x : more harm than Some parents and many doctors
Once exposed to wild chicken pox, you have immunity, which is important: The disease is almost always more serious in adults than in children.
We now have an epidemic of shingles among older children and adults which is far more expensive and actually far more painful than if we had let chicken pox remain endemic in the population, and used the vaccine selectively. �BARBARA LOE FISHER
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were surprised by the introduction in ���� o the chicken-pox vaccine as part o t he CDC ’s schedule o routine vacci nations. Vaccines have historically been developed to protect children against serious childhood illnesses, but chicken pox, a viral inection also known as varicella, has always been a mild disease. Until the vaccine was introduced, it caused about ��� deaths each year, �, � and about hal o those deaths were among children. According to Barbara Loe Fisher, coounder o the National Vaccination Inormation Center and co-author o the book A Shot in the Dark (����), about the dangers o the whole-cell pertu ssis vaccine, the vaccine was first designed or children with compromised immune systems, but once Merck & Co. had developed the vaccine, they needed to fi nd a market or it . � (Varivax, t he only chicken-pox vaccine used in the US , is made by Merck.) Now that the chicken-pox vaccine is required or enrollment in most public schools, there are ar ewer cases o chicken pox in t he US . On one hand, this is a good t hing: Fewer children mi ss school, parents don’t have to take time off work, and currently there are ewer than five deaths per year rom w ild chicken pox. Yet these positive benefits come with an unoreseen downside. Once exposed to wild chicken pox, you have immunit y, which is important: Te disease is almost always more serious in adults than in children. Previously, when wild chicken pox broke out in the general population, the immunity o adults who had been exposed to it as children would be boosted by periodically coming in contact with the di sease. But now that the natural immunization boost is effectively gone, this has led to growing numbers o baby boomers who had chicken pox as children getting shingles, a more serious disease caused
July–August 2009
by the chicken-pox virus. “We now have an epidemic o shing les among older children and adults which is ar more expensive and actually ar more painul than i we had let chicken pox remain endemic in the population, and used t he vaccine selectively,” explains Fisher. According to the CDC , approximately � mill ion people a year now get shingles, � and there is an increasing body o scientific data showing that the number o adults suffering rom shingles is on the rise. One study showed a �� percent increase in t he number o adults inected with t he Herpes zoster (shingles) virus i n Massachusetts rom ���� to ���� as the chicken-pox vaccine become more widespread.� Other studies have estimated increases as well. �, � John Grabenstein, Senior Medical Director, Adult Vaccines, Merck & Co., Inc., a rgues that the very slight recent rise in shingles—which, he says, is something Merck & Co. also ound in their shi ngles prevention study o more than ��,��� people �—is not related to the chicken-pox vaccine. “Shingles was with us even beore the childhood vaccine came a long,” Grabenstein points out. “It’s not correct to say that because we are vaccinating ch ildren, thereore adults are getting shingles.” � Instead, Grabenstein attributes the rise in shingles to the rising lie expectancy among American adults. “Te longer you live, the greater your risk o getti ng it,” he says. He discounts the idea that re-exposure to the wild virus circulating in the population provides a potential boost to the immune system and is preventive. “Your exposure to your grandk ids is a mi nor player,” Grabenstein insists. “Te dominant reason shingles occurs is that the immune system ages along w ith the body.” What everyone does agree on is this: shingles is a potentially serious and terribly painul disease. o address the shingles
g o od ? I S T O C K P H O T O . C O M
problem, Merck has developed a new vaccine: Zostavax, licensed by the FDA in May ����, and now being recommended or everyone over ��. Fisher finds t his troublesome. “You have a situation that was created by vaccination a nd you have a vaccine to counteract that situation,” she notes. It’s not only vaccine skept ics who are concerned. Dr. John E. rainer III , a amily physician in Jacksonville, Florida, who describes himsel a s “very pro-vaccine,” has questions about the cost o Zostavax a nd its effectiveness. “It’s a coin toss o efficacy,” he says. “I I give it to a ��-year-old, they are �� percent likely to benefit rom it. Tat means you can flip a coin and see whether it works or not. Te vaccine i s expensive, and the cost to the patient varies w idely, depending on insura nce coverage. My partner and I have not embraced the shingles vaccine.”�� In addition to the problem o an upsurge in shingles, the chicken-pox vaccine, which is a live virus, can cause several side effects that are as or more dangerous than the d isease itsel. Since the chicken-pox vaccine came into widespread use, reported react ions to it have included bleeding disorders, pneumonia, skin inections, severe rashes, and such nervous-system problems as Guillain-Barré Syndrome, encephalitis, and seizures. ��, �� wo young patients o Dr. Robert W. Sears who received the vaccine have developed benign thrombocytopenia, a blood-clotting disorder. �� Both o the chi ldren in Sears’s practice were hospitalized, and both took more than two months to recover. “Tis doesn’t make me stop giving t hat vaccine,” Sears states. “It just ma kes me realize t hat these reactions can happen.”
NOTES �. Department of Health and Human Services, Centers for Disease Control and Prevention, Vaccine Information Statement (Interim): Varicella Vaccine, “Chickenpox Vaccine: What You Need to Know,” �� U.S.C. (�� March ����): §���aa-��; www.cdc.gov/vaccines/pubs/vis/downloads/vis-varicella.pdf. �. For an extended discussion of how the CDC numbers may be misleading, see Brian Wimer, Jacquelyn L. Emm, and Deren Bader, “Chickenpox Party: Developing Natural Varicella Immunity,” Mothering ��� (January–February ����): ��–��; www.mothering.com/articles/growing_child/child_health/ chickenpox_party.html . �. Personal communication (�� January ����). �. Department of Health and Human Services, Centers for Disease Control and Prevention, “Vaccines and Preventable Diseases: Shingles Disease—Questions and Answers (Herpes Zoster)” (�� October ����): www.cdc.gov/vaccines/vpd-vac/ shingles/dis-faqs.htm. �. W. K. Yih et al., “The Incidence of Varicella and Herpes Zoster in Massachusetts as Measured by the Behavioral Risk Factor Surveillance System (BRFSS) during a Period of Increasing Varicella Vaccine Coverage, ����–����,” BMC Public Health � (�� June ����): ��. �. G. S. Goldman, “Cost-Benefit Analysis of Universal Varicella Vaccination in the U.S. Taking into Account the Closely Related Herpes-Zoster Epidemiology,” Vaccine ��, no. �� (� May ����): ����–����. �. G. S. Goldman, “The Case Against Universal Varicella Vaccination,” International Journal of Toxicology ��, no. � (September–October ����): ���–���. �. M. N. Oxman et al., “A Vaccine to Prevent Herpes Zoster and Postherpetic Neuralgia in Older Adults,” New England Journal of Medicine ���, no. �� (� June ����): ����–����; http://content. nejm.org/cgi/content/full/���/��/����. �. This and subsequent quotations: personal communication (�� April ����). ��. Personal communication (�� January ����).
Since the chicken-pox vaccine came into widespread use, reported reactions to it have included bleeding disorders, pneumonia, skin infections, severe rashes, and such nervous-system problems as Guillain-Barré Syndrome, encephalitis, and seizures.
��. See Note �. ��. Merck & Co. Inc., “Varivax: Varicella Virus Vaccine Live” (Whitehouse Station, New Jersey: November ����): www. merck.com/product/usa/pi_circulars/v/varivax/varivax_pi.pdf. ��. Personal communication (�� February ����).
—Jennifer Margulis
July–August 2009
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