Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Monday, March 19, 2007

More on Vaccines

Possibly contrary to the impressions of some anti-vaxers, I am not in favor of all vaccines. Not only are all vaccines not created equal, but not all vaccine-preventable diseases carry the same risks.

Specifically: I agree with Flea in his recent rant against the chickenpox vaccine. I can go him one further: from the beginning, I was against it for fear of a very specific unintended consequence. It turns out, in the fullness of time, that I am likely to be right.

Chickenpox is a mild disease of childhood that, prior to vaccination becoming widespread, killed fewer people annually in the US than cervical cancer. Children with suppressed immunity due to cancer chemotherapy or other conditions, of course, are at higher risk of chickenpox complications and therefore it makes sense to have a vaccine available to offer them. Chickenpox disease appears to confer longer-lasting immunity than vaccination. The problem is that chickenpox in adults is much more serious, with something like a 10% risk of pneumonia, which also carries a not-insignificant risk of dying. My fear was that immunizing children would lead to waning immunity in adulthood, with a corresponding increase in adult chickenpox, complications and death. Sadly, this is the road we appear to be taking.

I would also like to go on the record about the pros and cons of certain other vaccines that I feel are either unwarranted in children (or which should be considered optional, to be given at patient/parent's discretion instead of mandated across the board) or which should have research accelerated so they can be added to the standard vaccine assortment.

Hepatitis B

My problem with Hep B is that it was the first vaccine mandated for children that was not targeted against a childhood disease. World wide, the burden of Hep B is significant. In this country, this is not the case. So in the final analysis, we have a large population immune to a disease to which few will ever be exposed.

Human Papilloma Virus

I have ranted against the HPV vaccine -- Gardasil and others -- at length. Suffice it to say that at a minimum, I have issues with the marketing strategies used to promote this vaccine targeted against an organism that, again, causes a huge burden of suffering globally although much less in this country. The Blog that Ate Manhattan, among others, has posted far more eloquently (though not nearly, I daresay, as obnoxiously) as I on this topic. HPV vaccination should be optional, with informed consent being the operative paradigm.

Meningococcal Disease

Meningitis caused by Neisseria Meningitidis is a scary disease. It's the "meningitis" that kills healthy children and adolescents overnight. It's the one you read about in the papers. In young children, it used to be the third leading cause of meningitis after H. flu and S. pneumoniae ("pneumococcus") although it's been bumped up to second now that H. flu is gone the way of the dodo. It's fighting for first, too, as pneumococcus succumbs to Prevnar.

There are two vaccines against this frightening bug: Menomune and Menactra. Each protects against the four most common serotypes, and are currently recommended for students entering college and young people in other group living situations (ie, military recruits.) My heart was warmed by the recent expansion of indications for this vaccine to include all adolescents at age 11-12. I would love to see research completed so that this vaccine can be included in the routine vaccination schedule for infants.


At Mon Mar 19, 01:59:00 PM, Anonymous Anonymous said...

I'm kicking myself for not keeping the reference, but i remember reading that people who'd had the chickenpox vaccine have a greater incidence of shingles later in life. I think i'll take the minor inconvenience of chickenpox over risk of dealing with the pain and complications of shingles.

At Tue Mar 20, 10:57:00 AM, Anonymous Anonymous said...

I agree with this post whole heartedly, but i feel the GOVT. should not be able to force a person to get a vaccine like in texas where it has become a law to get the HPV vaccine for girls. Im sure there will be some major dealings with this in the future thats for sure.

At Wed Apr 04, 08:46:00 PM, Anonymous Anonymous said...

Dr. Dinosaur,

What are your thoughts on Hep A vaccination? Particularly for those living in areas with very little of it?

Maryland Doc


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