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.

Measles, Mumps & Rubella (MMR): As MMR inoculation rates have increased over the last three decades, so have autism diagnoses. Lisa Mayberry is one of a number of parents who watched her child develop the disorder after an MMR shot. "It's real hurtful to watch a child who is social and loving slowly slip away," she says. Doctors say such events can happen together by chance, without one directly causing the other. In June, a study of 498 autistic children published in the medical journal The Lancet found no epidemiological evidence linking the MMR vaccination to the disorder. The CDC is continuing to investigate.

Diphtheria, Tetanus and Pertussis (DTP or DTaP): In 1991, the Institute of Medicine in Washington concluded that the pertussis (or whooping cough) vaccine might, in rare instances, cause acute brain inflammation or a serious allergic reaction. Since then, a newer version of the vaccine, DTaP, has become available. It has fewer side effects such as fever and seizure. While the use of DTP has declined markedly, some doctors still administer it since it requires fewer inoculations. The CDC recommends DTaP: make sure your pediatrician's using it.

Chicken Pox, Polio and Rotavirus: Some parents choose not to vaccinate against chicken pox, a disease that usually causes nothing more than irritation. But in rare cases, serious complications--including pneumonia and brain damage--can occur in otherwise healthy children. As for polio, the CDC recommends that doctors discontinue the oral vaccine because it causes about 10 cases of vaccine-induced polio every year. The injectable vaccine harbors no such risk. The CDC also called a halt to the new rotavirus vaccine after reports of serious bowel obstruction in infants.

The debate over vaccines grew louder this summer after a series of heated hearings on Capitol Hill--and more questions will likely be asked as new vaccines are introduced. The most important thing parents can do is be knowledgeable. Make sure you read the vaccine information sheets your doctor is required by law to make available. You can find out more from the NVIC (800-909-SHOT or and the CDC (800-232-2522 or Report any symptoms after vaccination to your doctor, or contact the government-run Vaccine Adverse Event Reporting System (800-822-7967). As for skipping the shots entirely, it's not an easy option: most vaccines are required before children enter school. States allow certain exemptions, but by and large, educating your kids means inoculating them, too. So unless you're planning on home schooling, the best course is to educate yourself.