Necessary Shots?

Since the birth of her twin daughters last May, Theresa Sakamoto of Santa Monica, Calif., hasn't been getting much sleep. It's not just the babies who are keeping her up--it's Sakamoto's own internal debate over whether to vaccinate them. "If I knew my kids wouldn't have any [adverse] reaction, I would just do it. But I don't know that," she says. "On the other hand, not vaccinating them scares me... I still don't know what to do."

A generation ago, parents like Sakamoto didn't think much about the adverse effects of vaccines--they worried about the horrors of infectious disease. Today, potential killers like polio, diphtheria and now even measles are virtually unknown in the United States, while children are receiving more inoculations than ever--currently 19 for 10 different diseases. Now some parents are asking which is the greater threat: the viruses or the vaccines?

It's a fair question. Fear of viruses isn't what it used to be. The Centers for Disease Control and Prevention (CDC) in Atlanta recently revised its recommendations on the hepatitis B, polio and rotavirus vaccines because of concerns about adverse effects. Those changes have helped the cause of the National Vaccine Information Center (NVIC), an advocacy group in Vienna, Va. NVIC president Barbara Loe Fisher, who believes her son's learning disabilities stem from a severe vaccine reaction, charges that there is not enough research into possible links between vaccines and developmental disorders and chronic disease. Nor, she says, do parents receive enough information about the potential risks. She worries that bombarding children's immune systems with more and more inoculations could be dangerous. "We keep on developing more vaccines... to rid the world of disease," she says, but "could [vaccines] be doing something else which isn't so good?"

Public-health officials concede that the shots are never 100 percent risk-free. All vaccines go through rigorous safety trials before they're approved--but previously undetected reactions can show up later when larger numbers of children are inoculated. As for vaccine tolerance, infectious-disease specialists say there's no evidence that babies can't handle multiple inoculations: their immune systems are already assaulted with thousands of naturally occurring antigens within the first week of life. The doctors' bottom line is that the benefits far outweigh the risks. They worry that any drop in immunization rates could spawn new outbreaks of dangerous diseases. "A decision to vaccinate is a decision to protect not only your child," says Dr. Walter Orenstein, head of the CDC's National Immunization Program, "but other children in the community."

Here are some of the vaccinations now under debate:

Hepatitis B: The NVIC questions why all infants need protection against a virus spread largely through sexual intercourse and injection drug use. Health officials say it is possible for children to catch the disease through contaminated washcloths or toothbrushes. And while the risk of illness is much lower in children, the virus--which can cause liver cancer--is more likely to be fatal later if contracted early in life. The CDC recently recommended giving the injection within the first six months of life rather than at birth (except in cases where the mother tests positive for the disease). The reason: officials want to limit newborns' intake of thimerosal, a vaccine preservative containing mercury.