Dr. Lisa Rankin


This article was written on 03 Feb 2015, and is filled under LisaRankin.

The elephant in the room

Over the past week I have been getting lots of questions regarding the measles outbreak and vaccinating children that up to this point have not been vaccinated. It has been some time since we have seen an outbreak like this and it understandably creates some anxiety, especially when those exposed to the virus but not symptomatic have the ability to travel and disseminate before the illness presents.

Measles is a virus and like most viruses does not have any treatment that stops the illness in its track. Supportive care is given and you have to let it run its course. While most people will recover without problem there are complications for some. About 1 in 20 children will develop pneumonia which is a leading cause of death in young children with measles and 1 in 1000 will develop encephalitis(swelling of the brain) which can be fatal or leave signifiant residual deficits. Another rare but fatal complication is Subacute Sclerosing Panencephalitis which can develop 7 to 10 years after having the measles. This can happen even if the person seems to have recovered without any issues. These serious complications, in addition to the other less serious ones, are what led to the development of the vaccine. It is combined with mumps and rubella, which are also viral infections.

Because the MMR is a live attenuated vaccine it has the potential to cause an acute reaction at the time of vaccination such as encephalitis or an immune system reaction that may not present for several weeks or months. Along with other vaccines given to children it has been implicated it causing regression in previously normally developing children. There are genetic abnormalities that will make individuals more susceptible to having these adverse reactions but this information is not usually known prior to vaccines being given.

While it will never be possible to completely eradicate adverse reactions to vaccines it is possible to be smart about how vaccines are given to minimize negative outcomes. Avoid multiple vaccines at once and do vaccinate a sick child. Determine which vaccines are not really necessary in a small child and forgo until a later time. If you have children with autism delaying vaccines and using an extended schedule should be discussed. If family members have had issues with a particular vaccine you may need to avoid indefinitely or at least until normal development has been documented over time. If a documented autoimmune process such as Guillian-Barre has occurred in a family member discuss that with your provider when considering vaccines. Having a history of a mitochondrial disorder will also affect the decision how and when to vaccinate.

The bottom line is that there are some infectious diseases that can have serious outcomes and eradicating those diseases has had positive impact on the health of the majority of the population. We also need to recognize the fact that children are given many more vaccines in a very short period of time then they were just 30 years ago and that because of genetic and environmental influences this schedule can have a very negative and long lasting effect on some of them. It is up to parents to engage their medical provider in an intelligent conversation about vaccinations and what is the best schedule for their child. Ask questions and insist on thoughtful answers that are pertinent for your child. If your provider is not willing to have this conversation you should probably look for another provider.

Risk vs Benefit

Risk vs Benefit


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