The Browns brought little Joey in for his one-year physical. Both parents were pleased and proud of how well the baby was doing. He had made it through the winter with only one viral illness that was nothing more than a cold that lasted a few days. His growth was excellent, as evidenced by how his height, weight and head circumference symmetrically followed the 75th percentile on his growth curve. Developmentally, he was actually doing things that some 13-to-14 month olds are just beginning to do. Certainly they had every reason to be happy with how Joey was progressing.
As we began discussing the vaccinations that Joey would be receiving this visit, dad pulled out a folder and book. This book had obviously been well studied, as there were a number of yellow Post Its emerging from the pages. Dad laid the papers and book on the examining table. Then he scooted the chair close in order to present arguments as to why he wanted to modify Joey’s immunization schedule.
“My wife and I want to explore the possibility of Joey not getting the varivax vaccine for chicken pox until he is around six years old,” he said in a somewhat convincing voice. He looked at his wife, as if to get some moral support, and smiled when she quietly nodded in the affirmative. Thus his case was bolstered. I responded, “The standard of care in the United States is to give the varivax for chicken pox, MMR for measles, mumps and rubella, and the fourth and final Hib vaccine to ALL children at one year of age unless there is a specific contraindication.” They looked down and assumed a defensive posture. I went on, “This is not a personal decision on my part. These are the recommendations outlined by the American Academy of Pediatrics.”
Dad was no doubt anticipating my comments and held up the book that he had brought. “This book on immunizations was written by a medical doctor and the author says that she would not give the varivax until the child is five or six years old. She says, and my wife and I agree, that hopefully Joey will get chicken pox on his own, and will develop his own antibodies. We even plan to expose him to children who have the disease should the occasion arise,” he stated emphatically.
As I started to respond, he interrupted me. “I know what you are going to say, and just let me add that my wife and I will give him the vaccine by the time he starts first grade...if he doesn’t get the chicken pox by then.” When I asked him what his particular problem with the varivax was, he opened his book, then put it down. “First of all, my wife and I both had chicken pox when we were kids. Everyone got them. It was no big deal!” he responded. “The author of this book says that it is still possible to get a mild form of chicken pox even if you get the vaccine. She also says that the protection from the vaccine may not last that long which could theoretically require another vaccine later in life. We would just like to try insuring that Joey gets chicken pox on his own and be done with it.”
I thought for a moment before responding to his comments. “Until the introduction of the vaccine in 1995 chicken pox was, indeed, an inevitable part of childhood...almost a rite of passage. And for the most part it was a major inconvenience--an annoyance, if you will.” I went on. “Did you know that in 1995, the year the vaccine was introduced, there were four million cases of varicella in the United States? Ninety percent of these were in children. There were over 11,000 hospitalizations for varicella. Sixty percent of these admissions were for children. In 1995 there were 105 deaths from varicella and 45 percent were in children. Most of the mortalities were in healthy individuals.”
As he started to speak, I said, “Just let me add some of the common side effects of chicken pox. These include bacterial superinfection of the vesicles that can lead to permanent scarring of the skin.” His wife looked at me and said, “I have a number of scars from chicken pox that I got when I was three.” I went on the mention the other side effects that include encephalitis, meningitis, cerebellar ataxia and hepatitis.
I proceeded to discuss the safety of the vaccine. There have been over 40 million doses of varivax given to date. The adverse reactions that have been reported are not even close to the numbers or severity of side effects that would have been seen if these infants had acquired chicken pox on their own. As for the longevity of protection, time will have to tell. The Japanese have shown that there is protection for at least 20 years after the vaccine was given. This is being studied and tracked very closely. As for breakthrough cases, that is cases of chicken pox that occur over 42 days after receiving the vaccine, they do occur. But they are very mild cases with fewer than 50 lesions, little if any fever, and usually running its course in two-to-three days.
Clearly this was not what Joey’s dad wanted to hear. He was set on delaying these immunizations out of fear that something dreadful could happen as a result of the vaccine. And I truly understood that fear, especially with all the MIS information that saturates the Internet every day. Yet, dad had a book that was written by a medical doctor, and it supported everything that he wanted to do. Needless to say, I had not heard of the author, and the recommendations went against those of the American Academy of Pediatrics.
Joey’s dad was obviously torn about what to do. Not so his wife, as she said, “Let’s give it...why wait?” But dad was really conflicted as to what to do. I urged him to read literature from the American Academy of Pediatrics as well as the CDC. He should even call them so that he could make a truly informed decision. I told him that I would not give Joey any immunizations today, but that I wanted him to make a decision within a week. If he opted to NOT give Joey the varivax, I mentioned that I would honor his request. But he and his wife would have to sign a waiver explaining that the reasons for the vaccine were fully explained to them, the possible side effects from chicken pox were also explained, and they would assume all responsibility should this occur. Since the decision to NOT immunize Joey was against the standard of care, I had no option but to do this.
I will be seeing Joey and his parents back in a few days. I am curious to see what kind of a decision they have made.