TAKING SHOTS INFANT IMMUNIZATIONS UNDER FIRE.

Byline: Elizabeth Smilor Correspondent

Paulette Rock of Sherman Oaks did a lot of research before deciding to immunize her son Sebastian, now 1. What she found, especially on the Internet, was a lot of conflicting information.

``There's a huge community of people who don't believe in immunizations,'' she says. ``But I saw no direct medical association with the side against immunizations. So I thought the opposite - with all the viruses coming in, it's even more important to get immunizations.''

Tammy Johnson's research led her to a different conclusion. The Granada Hills mom says the information she read led her to forgo vaccinations for her 11-month-old daughter, Grace. She cited the National Vaccine Information Center Web site (www.909shot.com) as one that influenced her decision, despite knowing the site is not backed by any medical associations.

``Even if children are vaccinated, they can still get the disease - and they're at risk of getting it from the vaccination,'' she argues. ``I know the chance is very small, but I didn't want to take that risk. I'm not saying I have all the answers. It's just what felt right to me.''

The two families share the same pediatrician, Dr. Sloane Sevran of Encino, who is a strong advocate of immunizations. The Johnson family is the only one in Sevran's practice that chose to skip all vaccinations.

``I like that parents don't just blindly say, 'I'll do whatever you say,' but some places they're getting information from are nonmedical sources,'' Sevran says. ``A lot of my time is spent correcting misinformation.''

Dr. Christopher Tolcher, chief of pediatrics at West Hills Hospital, agrees.

``Now more than any time in history, there are concerns about vaccine safety,'' he says. ``My job is to acknowledge and dispel the risks.''

A University of Michigan study, published in the American Journal of Preventive Medicine in January 2001, found that 93 percent of all pediatricians reported that at least one parent had refused a vaccination for his or her child the previous year. Furthermore, 69 percent of physicians felt the number of vaccine concerns expressed by parents was increasing. About 19 percent of doctors said parents believe vaccines can affect their babies' immune system, and 16 percent said parents question whether their children need all of the recommended vaccines.

Local pediatricians say nearly all of the families they see decide to follow the childhood immunization schedule recommended by the Centers for Disease Control and the American Academy of Pediatrics. That's in line with a national rise in immunization rates, according to the CDC. However, reports linking some vaccines to autism or other severe disorders, along with the fact we rarely see diseases such as polio or diphtheria in this country, is enough to make many parents hesitate before a single shot goes into their baby's thigh.

``Our very success is in some ways our worst enemy,'' says Dr. Samuel Katz, professor of pediatrics at Duke University and co-chairman of the National Network for Immunization Information. ``Young parents haven't seen these diseases, but they're only a plane ride away.''

Protecting all of us

Curtis Allen, spokesman for the Centers for Disease Control and the National Immunization Program, is pleased immunization rates are going up but knows the trend could reverse at any time.

``As coverage increases, incidence of diseases decreases,'' he says. ``Unfortunately, many parents don't see these diseases, so they don't see the importance of immunizations. But these diseases are still circulating in many parts of the world.''

In July, the U.S. Department of Health and Human Services announced that the nation's childhood immunization rates are at record high levels. In 2003, coverage for the 4:3:1:3:3 series, which includes four doses of diphtheria, tetanus and pertussis, (DTaP), three doses of polio vaccine, one dose of measles-containing vaccine, three doses of Hib vaccine, and three doses of hepatitis B vaccine, increased to 79.4 percent, compared to 74.8 percent in 2002, 73.7 percent in 2001 and 72.9 percent in 2000. In Los Angeles County, the rate was 80.3 percent in 2003.

Any slip in the immunization rate, though, can have a devastating affect, Allen says. He explained the concept of ``herd immunity'': The more people who are vaccinated, the less likely it is that even those who are not vaccinated will get the disease. However, if overall immunization rates fall for any disease, or if a large percentage of families in the same community do not immunize their children, outbreaks are more likely.

In the early 1990s, the measles immunization rate fell and an epidemic occurred. About 55,000 children got the measles, 120 died, and 11,000 were hospitalized, Allen said. Likewise, one of the highest per capita rates of whooping cough (pertussis) in the United States is in Boulder, Colo., where a group of parents have chosen not to immunize their children.

``It's easy to say that overall the number of children not immunized is small, less than 2 percent, but if in one area it's 8 or 9 percent, that may be enough of a spark to start a fire,'' Katz says, referring to the outbreak in Boulder.

Risks vs. benefits

Kenneth Claborn, a Granada Hills chiropractor who lives in Valencia, says his extensive research swayed him not to vaccinate his 10-month-old son. He doesn't worry about his son contracting the diseases, primarily because he doesn't hear about many cases in the U.S. He worries vaccinations could have a negative effect on his child's developing nervous system.

``My philosophy as a chiropractor is that the body has the natural ability to heal itself,'' he says. ``I might vaccinate him when he's a little older, but at a young age the risks are not worth the benefit.''

The single largest concern among parents, pediatricians say, is the possibility vaccines could cause autism. This fear grew in 1998 when a medical report published in the Lancet suggested a link between autism and the measles, mumps and rubella (MMR) vaccine. In March of this year, 10 of 13 authors of that report retracted their findings.

Studies since 1998, including a 2002 landmark study from the Danish Epidemiology Science Center that followed more than 500,000 children over seven years, have found no link between autism and the MMR vaccine.

Many studies have also looked at possible risks associated with the use of thimerosal, a mercury-based preservative, in vaccines. No scientific study has found a link between thimerosal and autism or other disorders.

In May, the Institute of Medicine reviewed clinical and epidemiological studies and concluded that neither thimerosal or the MMR vaccine is associated with autism. The Institute of Medicine is a nonprofit organization that works outside the framework of government to provide unbiased, evidence-based information to the public.

Despite a lack of scientific evidence against thimerosal, the preservative was phased out of childhood vaccinations as a precaution beginning in 1999, Allen said. All the vials containing thimerosal expired in 2003, he added.

``We take vaccine safety very seriously,'' Allen says. ``We're constantly monitoring the safety of vaccines.''

New options

A newly recommended vaccine for children this year is the flu shot. It's also the one vaccine that might contain the preservative thimerosal. Parents can request the thimerosal-free version, Allen said. There will be up to 8 million doses made of this version, he said. ``We would need 12 million doses to vaccinate all children in the recommended age group. We estimate that a maximum of 40 percent will get the shot,'' Allen said.

The CDC is recommending a flu shot this year for children ages 6 months to 2 years, Allen said. They're also strongly advising parents, older siblings and caregivers to get the shot.

``Young children who get the flu have complications leading to hospitalization at a rate nearly equal to that seen in adults 65 and older,'' he said.

He suggests parents make an appointment now for October or November. Children receiving the flu shot for the first time receive two shots a few weeks apart.

The chickenpox (varicella) vaccine is a recent addition to the immunization schedule. Before the introduction of the vaccine in 1995, approximately 4 million cases of chickenpox occurred annually in the United States, resulting in approximately 11,000 hospitalizations and 100 deaths, according to the CDC.

``Many parents think chickenpox is a rite of passage,'' Allen says. ``But it's still a miserable disease for kids.''

The other new addition is the pneumococcal pneumonia vaccine, marketed as Prevnar. Pneumococcus is a bacteria that causes serious infections in adults and children, including pneumonia, blood infections and meningitis. It's also the No. 1 cause of sinusitis and ear infections. A four-dose series of the vaccine is recommended, though a shortage reduced that to three doses. The CDC expects the supply will support a four-dose schedule soon.

Parents now have the option of eliminating a few shots by requesting new combination vaccines. However, many insurance companies will not cover the higher cost of these shots. Kaiser Permanente switched to a new five-in-one vaccine two years ago, says Marlene Lugg, immunization coordinator at the Panorama City Kaiser hospital. The shot combines the DTaP, hepatitis B and polio vaccines. Using it eliminates two shots at 2, 4 and 6 months of age, Lugg says.

She says she expects more combination vaccines to be introduced once more research is conducted. She's hopeful that continued research will reassure parents and lead to higher immunization rates. ``My kids had mumps, rubella and chickenpox,'' she says. ``I'm glad my grandkids won't have these.''

CAPTION(S):

3 photos, box

Photo:

(1 -- cover -- color) Heeding the cry

Controversy surrounds infant immunizations

Photo illustration by Shane Michael Kidder

(2) Dr. Sloane Sevran prepares to give Sebastian Rock an MMR immunization at her Encino office. And while more parents are concerned about shots, the pediatrician says only one family in her practice has refused all immunizations.

(3) no caption (needle)

Photo by David Sprague/Staff Photographer

Box:

RECOMMENDED CHILDHOOD AND ADOLESCENT IMMUNIZATION SCHEDULE

SOURCE: Centers for Disease Control and Prevention