PEDIATRICS Vol. 110 No. 3 September 2002, pp. 648-649
Too Many Vaccinations?
To the Editor.—Offit and colleagues1 have shown, with their review on the ability of the immune system to generate antibodies, that one particular concern of parents is unfounded. Their article is a good starting point to discuss further the concerns held by patients and doctors. Over the past 30 to 40 years, together with the decline in acute infectious diseases because of immunization programs, a steady increase was seen in chronic noncommunicable diseases in childhood. Research suggests that the cause for the increase in these illnesses may be found in environmental exposures operating in early life. Disordered immune regulation, the hygiene hypothesis, Th1/Th2 balance, and influences on the commensal flora have all been suggested to explain this trend. The mortality and morbidity rates of communicable diseases at the start of immunization programs have not been compared yet with the increasing burden of noncommunicable diseases. These chronic diseases not only contribute to an increase in morbidity, which will be lifelong rather than having mainly an acute phase, but also account for an increasing mortality rate. For example, in America currently 100 to 150 children will die from anaphylactic shock resulting from food allergies, and this trend is expected to continue to rise.2 Articles should follow comparing the decreasing trends in burden of communicable diseases with that of the increasing trend in noncommunicable diseases in childhood. Second, the notion of nonspecific side effects of vaccines should be reviewed to investigate whether the increasing vaccination coverage over the past 30 to 40 years is associated with the increase in chronic noncommunicable diseases. Many parents believe that health professionals should provide more balanced information.3 Articles that continue to address parents’ and doctors’ concerns in this area would do justice to their demands for further vigilance. "Public health research to support public health interventions is not a luxury but a necessity."4
Wouler Havinga
St Luke’s Medical Center
Stroud, United Kingdom
REFERENCES
- Offit PA, Quarles J, Gerber MA, et al. Addressing parents’ concerns: do multiple vaccines overwhelm or weaken the infant’s immune system?
Pediatrics.2002; 109
:124
–129
[Abstract/Free Full Text] - Sampson HA. What should we be doing for children with peanut allergy? J Pediatr.2000; 137 :741 –743[Medline]
- Sporton RK, Francis SA. Choosing not to immunize: are parents making informed decisions?
Fam Pract.2001; 18
:181
–188
[Abstract/Free Full Text] - Mulholland K, Barreto ML. Lessons can be learnt from this study.
BMJ.2001; 322
:360
[Free Full Text]
In Reply.—
Dr Havinga asks for studies to address the concern that vaccines given early in life increase the risk for chronic diseases of childhood. He argues that the decline in acute infectious diseases (the "hygiene" hypothesis) caused by immunization over the past 30 to 40 years has paralleled an increase in chronic diseases. Unfortunately, broad ecological observations cannot determine causality. Current vaccines that target specific, well-defined serious illnesses of children would at most constitute only a small part of the large number of "hygienic" changes that have occurred in lifestyles and public health practices. For example, changes in the quality or amount of food additives, antibiotics, environmental pollutants, or car emissions have also occurred during the past few decades.
Dr Havinga asks for studies that examine the relationship between vaccines and chronic diseases. It is important to recognize that vaccine safety is continually monitored for both immediate adverse events and longer-term risks even after vaccines are licensed. Excellent studies performed by the Vaccine Safety DataLink (a program directed by the Centers for Disease Control and Prevention) and others have not supported the hypothesis that vaccines cause chronic diseases such as type 1 diabetes,1 asthma,2 or multiple sclerosis.3,4 Although we must be constantly vigilant of vaccine safety by continued study, all the data we have thus far are reassuring. The theoretical explanations stated by Dr Havinga for the association between vaccines and chronic diseases remain, at best, theoretical.
Finally, we agree with Dr Havinga that information presented to parents should be "balanced." But balance regarding issues of vaccine safety only occurs when data regarding the known benefits and risks of vaccines are presented. Discussions that include theoretical risks, unfounded hypotheses, and unconfirmed data will only mislead and confuse.
Paul A. Offit, MD
Children’s Hospital of Philadelphia
Philadelphia, PA 19104-4399, USA
Michael A. Gerber, MD
Children’s Hospital Medical Center
Division of Infectious Diseases
Cincinnati, OH, USA
Charles Hackett, MD
Division of Allergy, Immunology, and Transplantation
National Institute of Allergy and Infectious Diseases/NIH
Bethesda, MD, USA
Edgar Marcuse, MD
Section of Infectious Diseases
Children’s Hospital Medical Center
University of Washington School of Medicine
Seattle, WA, USA
Bruce Gellin, MD, MPH
Department of Preventive Medicine
Vanderbilt University Medical Center
Nashville, TN, USA
REFERENCES
- DeStefano F, Mullooly JP, Okoro CA, et al. Childhood vaccinations, vaccination timing, and risk of type 1 diabetes mellitus. Pediatrics.2001; 108(6) Available at: http://www.pediatrics.org/cgi/content/full/108/6/e112
- Nillson L, Gruber C, Granstrom M, et al. Pertussis IgE and atopic disease. Allergy.1998; 53 :1195 –1201[Web of Science][Medline]
- Confavereux C, Suissa S, Saddier P, et al. Vaccinations and the risk of relapse in multiple sclerosis.
N Engl J Med.2001; 344
:319
–326
[Abstract/Free Full Text] - Ascherio A, Zhang S, Hernan M, et al. Hepatitis b vaccination and the risk of multiple sclerosis.
N Engl J Med.2001; 344
:327
–332
[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2002 by the American Academy of Pediatrics
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