Delayed Vaccination Schedule

[Michele]

In vet med nursing really affects vaccine efficacy which is what spotty dog referenced. The maternal antibodies in the milk neutralize the vaccine before the puppy can mount an immune response.

I don't know the human studies or if there have even been any, but I would think breastfeeding has similar effects. I tried researching this but quickly got bogged down and lost my focus.

The CDC and Academy likely assumed formula feeding and high exposure risk when creating their schedules. I think it'd be interesting to see how maternal antibiotics affect immunity stimulated by a vaccine. For my kids I'm comfortable with exclusive breastfeeding and no daycare exposure. Since mine are all in daycare at least once a week I'm quickly catching Phe up, but for the year she was home with me I wasn't too worried. And I don't think she was a risk to other kids because she wasn't vaccinated. I was taking the risk of her developing a severe disease or complication, but if she was sick I wasn't parading her through the park/library/playdates. Snotty noses don't count as sick to me though. Fever and rashes do count. Vomiting and diarrhea also count.

[SuzySunshine]

We have a couple of friends who are peds and a friend who is "crunchy" as I like to call her. I was pleasantly surprised when talking to them that they all supported doing them on your own schedule as long as you get them. The crunchy friend truly believes you need the vaccines but she doesn't agree with giving them more then 2 shots per visit and she'd really prefer 1. So she pays the extra co-pay to go in every couple of months, or as needed to get them but spread out over time. I think if you're truly concerned about stacking them that is the way to do it and I'd have real concerns with a doc who wouldn't let you space them out even just a little bit.

[TulipsAndSunscreen]

Absolutely, like any parenting decision, this is totally up to the parents! Definitely think everyone has to make their own decision based on their child's possible exposure, etc.

For me personally, I would count DH working in a hospital as high risk (especially in ICU or SICU rotations) plus our baby will be in daycare so our baby will be vaxed on time. For others who exclusively breast feed and don't send their children to daycare, I can understand the other position.

[scarlett09]

Your point is interesting ST. I wonder if the peds are actually supporting the position of delayed vax vs. letting the parents choose vs. serving a niche that they feel still needs care? I would be very interested in speaking with a pediatrician who feels this way since I believe (though I'm not 100% certain) that the American Academy of Pediatrics still supports the CDC-recommended schedule. FWIW, I researched 3 peds in Cleveland and none of them allow non/delayed vax. Maybe it's a regional thing but they were all adamantly against it.

Not sure how DH's co-workers feel about the vax schedule, but I know that DH feels very strongly about the recommended vax schedule for his clinic patients and wouldn't be accepting of non-vax patients if he were going into PP. He is firmly for the vax schedule recommended by the CDC, AAP, and AAFP, which is available here: http://aapredbook.aappublications.or...dule0-6yrs.pdf. There is also a recommended "catch-up" schedule: http://aapredbook.aappublications.or...uleCatchup.pdf.

Interesting article in the November issue of Pediatrics about a study on why parents choose alternative vax schedules: http://pediatrics.aappublications.org/content/128/5/848. The AAP also has a joint initiative, CISP, with the CDC regarding immunizations; their website is a resource for both parents and peds: http://www2.aap.org/immunization/index.html.

I have to say that finding the AAP's exact policy on vax schedules was kind of annoying. Most of the up-to-date info is available to members only through the AAP Red Book, which I don't have access to. Here is what I was able to dig up: http://aappolicy.aappublications.org...rics;127/2/387.

[Vanquisher]

I don't know...it wasn't that hard to find a ped that was okay with an alternate vaccination schedule. I came across several in the DFW area with just a little research. There are a couple that support non-vax too, but I didn't go with any of them. One was admittedly a little "out there" but very popular. But hey...they are pediatricians too. They went through the same training. Shouldn't their opinions be valid, too? Most would argue you are making an uneducated decision if you choose to delay, but these ARE the educated experts in the area.

No, their opinions aren't valid, and I will tell you why.

$$$$$ Money. They almighty dollar. The more you have to see patients for easy visits, the more the peds get paid for less work. Plus, it adds a whole new client base that a lot of pediatricians refuse to see. I would bet on it. I would guess that the correlation between people with money and decent health insurance who research delayed vaccinations and/or no vaccinations is quite high. Running a private practice is a business. Make no mistake. AND, it is a hard business. It's hard to make money and get paid.

I actually think it is fairly unethical and irresponsible for a doctor to condone no vaccinations as it is definitely not supported in the literature, and, I'm sorry, I don't feel like this is a parent choice thing. It's a public health thing. People are stupid enough to believe Jenny McCarthy (an actress who has made a lot of money with her immunization claims) and ONE fraudulent/discredited doctor over ALL of the other literature and studies. Delayed vaccinations? I'm not really on board with that either, but it is better than no vaccinations.

I would bet that most of the docs who either allow patients to non-vax or delayed vax do not do it for sound health reasons (other than rationalizations that SOMEONE has to see these kids), but rather to get their copays, deductibles, co-insurance, and insurance payments.

[niener]

Plus, it adds a whole new client base that a lot of pediatricians refuse to see. I would bet on it. I would guess that the correlation between people with money and decent health insurance who research delayed vaccinations and/or no vaccinations is quite high.

Totally. Parents choosing to delay vaccinations is a growing niche market and more and more pediatricians are wising up to the fact that they can tap into this market of probably mostly middle class/upper middle class families and higher with good health insurance. Some of them may genuinely believe delayed vax is preferable, but I would bet you most of them just see a business opportunity.

For kids who spend a significant amount of time outside of the home or with people who are exposed to some of this nasty stuff all the time, I think sticking to the standard schedule is important. For everyone else, it's more situational. I would think the interval between shots in a series would matter more than when the series was started, again assuming the kids aren't high-risk.

This thread is about to belong in the debates forum

[SoonerTexan]

It should already be there. Can it be split off from the original topic?

[niener]

Admins are awesome

[scrub-jay]

You ladies were right, it is far more appropriate here. (Side note: I'm not sure I did it right, let me know if I missed any posts and I'll fix it)

P.S. I'm just a lowly moderator who likes to make our admins lives a little better!!

End hijack/

Carry on!!

[scarlett09]

$$$$$ Money. They almighty dollar. The more you have to see patients for easy visits, the more the peds get paid for less work. Plus, it adds a whole new client base that a lot of pediatricians refuse to see. I would bet on it. I would guess that the correlation between people with money and decent health insurance who research delayed vaccinations and/or no vaccinations is quite high. Running a private practice is a business. Make no mistake. AND, it is a hard business. It's hard to make money and get paid.

I actually think it is fairly unethical and irresponsible for a doctor to condone no vaccinations as it is definitely not supported in the literature, and, I'm sorry, I don't feel like this is a parent choice thing. It's a public health thing. People are stupid enough to believe Jenny McCarthy (an actress who has made a lot of money with her immunization claims) and ONE fraudulent/discredited doctor over ALL of the other literature and studies. Delayed vaccinations? I'm not really on board with that either, but it is better than no vaccinations.

I would bet that most of the docs who either allow patients to non-vax or delayed vax do not do it for sound health reasons (other than rationalizations that SOMEONE has to see these kids), but rather to get their copays, deductibles, co-insurance, and insurance payments.

I agree with you totally on this. I'm sure there is a niche market for this type of care, which seems a lot like concierge med IMHO. It's not supported in the literature. There is a whole reporting system called VAERS, created by the FDA and the CDC, that gives healthcare professionals an avenue to report any serious side effects of vaccinations: http://vaers.hhs.gov/index

I feel as though any ped who wants to support this stance may be supporting themselves/their families/their PP with these types of patients, but in the end they are doing a complete disservice to other children/parents/peds who choose to vaccinate. It is difficult to be in PP, but don't physicians have a duty to protect the health of their patients, a duty that is above the almighty dollar?

What also continues to blow my mind is that we have these things readily available to us, miracles of modern medicine that protect our children from nasty, terrible illnesses and diseases. DH is going to Haiti to give vaxs to children who suffer from illness and disease because they do not have the resources readily available to them. The children and their parents are grateful for the vaxs and the care they receive, as it may help more children there live past the age of 5. Yet here, we are ungrateful for the resources we have and we shrug off miracles of modern medicine because two quacks have claimed they are "bad". My favorite quote is from my dear friend whose 10 year old DS has autism: "if shots gave J autism, then how come the other kids getting their shots the same day in the same doctor's office didn't get it too?"

Totally. Parents choosing to delay vaccinations is a growing niche market and more and more pediatricians are wising up to the fact that they can tap into this market of probably mostly middle class/upper middle class families and higher with good health insurance. Some of them may genuinely believe delayed vax is preferable, but I would bet you most of them just see a business opportunity.

For kids who spend a significant amount of time outside of the home or with people who are exposed to some of this nasty stuff all the time, I think sticking to the standard schedule is important. For everyone else, it's more situational. I would think the interval between shots in a series would matter more than when the series was started, again assuming the kids aren't high-risk.

This thread is about to belong in the debates forum

I also agree with you. I understand that some kids may belong on the alternate vax schedule recommended by the AAP, CDC, and AAFP (not one they created themselves) for one reason or another (mainly illness). And that there are parents who fall behind on the kids' shots for a variety of reasons. But given the opportunity by our healthcare system to protect ourselves and our children from illness and disease, why wouldn't one want to keep their kids on time and on schedule (if access and finances are not an issue)?

An important side note: I am not giving the choices any of you all make about vaccinations for your kids the stink-eye here. It is just how I feel about this issue, which is heightened by living with a ped. I think houseelf said it best in another thread that "parenting is a gray area" and that you "do what is best, with all the love in your heart and a clear conscience, and hope for the best" (I'm paraphrasing here, but you get the jist of her wonderful statement).

AAP links:
http://www.healthychildren.org/Engli...The-Facts.aspx
http://www.healthychildren.org/Engli...e-Effects.aspx

CDC links:
http://www.cdc.gov/vaccines/vac-gen/default.htm
http://www.cdc.gov/vaccines/vac-gen/side-effects.htm
http://www.cdc.gov/vaccines/vac-gen/6mishome.htm

[Vanquisher]

I feel as though any ped who wants to support this stance may be supporting
themselves/their families/their PP with these types of patients, but in the end
they are doing a complete disservice to other children/parents/peds who choose
to vaccinate. It is difficult to be in PP, but don't physicians have a duty to
protect the health of their patients, a duty that is above the almighty
dollar?

Yes. I believe going against recommended courses of treatment for purely monetary gain is completely unethical. I have actually heard of more peds offices requiring their patients to follow recommeded vaccination schedules in order to receive treatment and other care in their practices. It's unfortunate that a lot of physicians feel they have to set these kind of boundaries, but I applaud them for it. If your patients won't comply with recommeded care and put your other patients at risk because of their refusal to do so, then I can absolutely see why these policies are in place. When I was in the waiting room a few weeks ago for our yearly visit with the kids, the receptionist fielded a phone call regarding whether this particular practice required vaccinations. They do.

On the opposite side of the money angle for accepting patients who want to delay vax and/or not vax at all, I bet the parents of patients who choose not to vax are largely (NOT always) a giant time suck and PITA. It's just something I have seen. They are more likely to dissect and question every single medical decision or recommendation that the ped makes. It's not that parents who vax don't do these things. I would just bet that the correlation of time suck is higher.

In our practice, we have a few patients who are just an enormous time suck. DH likes to spend time with his patients, but at some point, it isn't productive anymore, let alone cost effective! I am constantly telling dh to go faster! He sees it as being a worse doctor and a bigger asshole to cut patient conversations off. It's a balance, but I feel like I should put an egg timer at the nurse's station. After a certain amount of time, the buzzer goes off, and he needs to get OUT.

[SoonerTexan]

I think I should note for anyone who hasn't read the Sears book we were talking about that he doesn't engage the autism argument at all because (in his words) there is no evidence to support it. Mind you, this book was published before the big revelations of this year. Also, I'll have to check again, but much of his schedule spaces vaccines over multiple appts, not months or years, though I believe some of them are pushed out further. I can't see how someone could be upset about A kid getting shots weeks apart as opposed to more than 3 at a time if the parent is willing to schlep the kid to the appt and pay the extra $$$. That seems a little nitpicky.

[TulipsAndSunscreen]

I have posted the schedules below. One thing that bothered me about Dr. Sears schedule (at least as I understand it) is that he recommends MMR separately which is REALLY hard to find (basically impossible according to some message boards I've read). This leads many parents to delay it until his latest recommended start time which means some kids aren't protected from MMR until 3.5 years.

CDC Recommended Schedule:

At birth
Hep B

2 Months
Hep B (second dose should be given between 2 months and 4 months)
Rotavirus
DTaP
Hib
PCV
Polio

4 Months
Rotavirus (second dose)
DTaP (second dose)
Hib (second dose)
PCV (second dose)
Polio (second dose)

6 Months
Hep B (third dose should be given between 6 months and 18 months)
Rotavirus (third dose)
DTaP (third dose)
PCV (third dose)
Polio (third dose should be given between 6 months and 18 months)
Influenza (and given every year until at least 19 years old)

1 year
Hib (third dose should be given between 12 months and 15 months)
PCV (fourth dose should be given between 12 months and 15 months)
MMR (first dose should be given between 12 months and 15 months)
Varicella (first dose should be given between 12 months and 15 months)
Hep A (starting at 1 year, two doses are needed at least 6 months apart)

15 months
DTaP (fourth dose should be given between 15 and 18 months, as long as it is six months after the third dose)

4 to 6 years
DTaP (fifth dose)
Polio (fourth dose)
MMR (second dose)
Varicella (second dose)

11 to 12 years
HPV (for girls, three doses should be given over the span of six months)

Dr. Sears:

2 months
Rotavirus
DTaP

3 months
PCV
Hib

4 months
Rotavirus (second dose)
DTaP (second dose)

5 months
PCV (second dose)
Hib (second dose)

6 months
Rotavirus (third dose)
DTaP (third dose)

7 months
PCV (third dose)
Hib (third dose)

9 months
Polio
Influenza (and given every year until at least 19 years old)

12 months
Polio (second dose)
Mumps (separated from MMR)

15 months
PCV (fourth dose)
Hib (fourth dose)

18 months
DTaP (fourth dose)
Varicella

2 years
Rubella (separated from MMR)
Polio (third dose)

2 1/2 years
Hep B
Hep A

3 1/2 years
Hep B (second dose)
Measles (separated from MMR)

4 years
DTaP (fifth dose)
Polio (fourth dose)

5 years
MMR (second dose of each vaccine)

6 years
Varicella (second dose)

12 years
HPV

12 years, 2 months
HPV (second dose)

[Pollyanna]

I think doing five shots at once is unnecessary and creates difficulty in determining which vax your child may be reacting to. We do no more than three at a time but prefer to keep it to two. I just go in for a nurses visit in between. No big deal. But our pediatrician knows us and trusts we will keep our kiddos up to date on their shots.

[Thirteen]

I dropped the ball with DS after our relocation (3 weeks on single parent duty, in a new place, trying to set up a household will do that to you) and he was behind until 8 months of age.
He has received all the recommended shots by CDC, and the most we ever had at once was 2 in each leg. I felt bad about it at the time, but those were par the course for his 8 month vax, and not because I chose to "catch up" all at one setting.
I have to be honest that before he was 8 months, I was exceedingly uncomfortable letting him play in any public space, even with friends.
I will also admit to being a little apprehensive when I discovered that a mom I know has not vaccinated her children AT ALL against anything. With the Measles outbreak in CA last year, and the rise of Pertussis, it just doesn't seem wise. I also believe that, having a partially blank vax record from childhood myself, allows me to see both sides of the coin. I have posted before about my own experiences surrounding the supposed "autism/vax" link, and it pains me to know that this is still being toted as fact.
My brother is autistic. He was born autistic, vaccinations did not make him that way.