Vaccine Jitters

By LEON JAROFF

They are painful rites of passage for American children, from infancy through elementary school. Kids dread them, their parents reluctantly accept them, and the government mandates them. And, until recently, few really questioned the need for--or the safety of--vaccinations.

Now, alarmed by reports of severe reactions, a series of unsettling announcements by health authorities and contentious congressional hearings, not to mention fear-mongering on the Internet, a small but growing number of parents are contesting national vaccination policy.

They suspect that the fusillade of 22 injections imposed on children by age six may, alone or in combination, pose significant dangers. Although the evidence is largely anecdotal, some parents charge that inoculations have brought on such disorders as multiple sclerosis, rheumatoid arthritis, chronic fatigue syndrome, diabetes and even autism.

Doctors and medical associations are disturbed by the antivaccine sentiment in some communities. They fear that it could erode public confidence in the nation's largely successful vaccination policies and lead to outbreaks of many infectious diseases now held in check by inoculations.

The value of vaccinations is most obvious to those who remember row upon row of iron lungs occupied by victims of polio epidemics and the quarantine signs posted on the homes of people stricken by diphtheria, whooping cough, smallpox and measles. Of these scourges, smallpox has been wiped out and the others have become rare and largely preventable through the use of vaccines. Says Duke University pediatrics professor Samuel Katz, a leading authority on vaccines: "Immunization is the single intervention that has most dramatically reduced childhood morbidity and mortality."

Vaccines, of course, aren't without risk. A slight possibility always exists that those containing live but weakened viruses--oral polio, measles and mumps vaccines, for example--could trigger the disease they're intended to prevent. And a few vaccines originally thought to be safe have caused side effects so severe in a small percentage of inoculated children that they've had to be modified or temporarily withdrawn.

Though the last naturally caused case of polio in the U.S. was in 1979, recent announcements and recalls by government agencies have drawn public attention to the real if very small risks of inoculation. Each year an average of eight children are infected with polio by the otherwise highly effective Sabin oral vaccine, which is made from live but attenuated polio viruses. This danger was highlighted in June, when the Food and Drug Administration recommended the Salk killed-virus vaccine, which is safe but somewhat less effective, instead of the Sabin variety, for the first two of the four required polio inoculations given children. The two additional Sabin vaccinations would be deferred until the kids are out of infancy.

In July the American Academy of Pediatrics and the U.S. Public Health Service urged vaccine makers to remove the trace of mercury preservative added to many vaccines to kill bacteria. While the amount of the additive, called thimerosal, in a single vaccine poses no threat, it's remotely possible that the accumulated mercury in multiple inoculations might cause neurological damage. "We took action before evidence of any harm," says Dr. Walter Orenstein, head of the national immunization program for the Centers for Disease Control. "But even with a theoretical risk, we wanted to work with manufacturers to get to thimerosal-free products as soon as possible."

The academy has pushed back the age for the first of three hepatitis-B shots, which also contain thimerosal, from birth to two to six months in children whose mothers test negative for the disease.

Shortly after that the CDC called a halt to all inoculations with RotaShield, a new vaccine made available last year. It was designed to protect infants from potentially fatal rotavirus infections, which cause severe diarrhea and dehydration. The agency's action followed word that 23 infants suffered a collapsed bowel after getting the vaccine.

More concerns were raised last month when a congressional-subcommittee hearing learned that DTP, a combination vaccine for diphtheria, tetanus and pertussis (whooping cough), is still on the market. As far back as 1994 the Institute of Medicine and the National Academy of Sciences warned that DTP was responsible for cases of brain inflammation and permanent brain damage. A safer version, called DtaP, is now recommended by the CDC.

"You trust that the government is doing things to protect your child, but the reality is that the benefits no longer outweigh the risks," insists Los Angeles attorney Nadine Gehr, who claims her son became autistic after receiving a DTP shot. "My child was fine. Then he was vaccinated, and within three or four days he was a different child."

The widely used MMR (measles, mumps and rubella) vaccine has also been suspected of causing autism, yet there is no definitive scientific evidence to connect any vaccines to the still mysterious behavioral disorder. Indeed, doctors claim that the onset of autism often occurs in toddlers at the same time they are scheduled for shots and is likely to be entirely coincidental. A recent study in the journal Lancet found that in Britain rates of the disorder are similar among vaccinated and unvaccinated children.

Still, parental concerns are understandable. After her 2 1/2-year-old son had a convulsion following a DTP shot and developed learning disabilities, Barbara Fisher, of Vienna, Va., entered the vaccine debate by co-founding the National Vaccine Information Center, a clearinghouse of vaccine data. Says Fisher: "If you question the vaccines, you are somehow [regarded as] bringing death and disease to this country."

But problems could arise if questioning leads to exemptions from state-mandated shots or even boycotts of them, which people in some communities are calling for. The CDC estimates that only 78% of U.S. two-year-olds have been given all the recommended inoculations.

Those statistics could spell trouble. Dr. Jon Abramson, chairman of the pediatrics academy's immunization committee, recalls that between 1989 and 1991, when many people were becoming wary of vaccines, measles-immunization rates dropped 10% and an outbreak ensued, resulting in 55,000 cases, several thousand hospitalizations and 120 deaths. "Since we started immunizing again," Abramson says, "there have been very few outbreaks of indigenous measles."

Paradoxically, the near eradication of many diseases in the U.S. has caused many Americans to risk dispensing with vaccinations. "Today's parents don't know about polio and diphtheria," says Dr. Natalie Smith of the California Department of Health Services. Nor, she warns, are they always aware that in a shrinking world, polio and other infectious diseases can be "only a plane ride away." These are points that parents surely ought to consider if they're thinking of not getting their kids vaccinated.

--Reported by Ann Blackman/Washington, Jeanne McDowell/Los Angeles and Alice Park/New York

With reporting by Ann Blackman/Washington, Jeanne McDowell/Los Angeles and Alice Park/New York