Pediatrician Gripe: Splitting Up Vaccinations

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The Offending Statement

"It seems like too many vaccines are being administered today; can we split up them up over the course of multiple visits?"

Vaccines have weathered their fair share of criticism. First, there were concerns that the hepatitis B vaccine caused multiple sclerosis, then it was presumed that the MMR vaccine caused autism, and you have certainly been bombarded by the latest medical "fact" that the preservative thimerosal (the infamous mercury preservative used in vaccines prior to 2000) is at the root of the autism epidemic.

Now that these theories (and more!) have been disproven, there is a new concern being floated out to parents: The number of vaccines being administered to infants under two years of age is a health hazard because too many vaccines can overwhelm a baby's immune system. Welcome to the vaccine concern du jour!

Why We Don't Want to Hear It

Stress on the immune system of a child is difficult to measure. Sometimes stressors can even be a necessary part of development: Viral exposure such as a runny nose (a common infant phenomenon) challenges the immune system and is a stress, but a cold will generate immune protection, which is something every child needs in order to live normally. The body endures these invasions by viruses and bacteria (some of them symptom-free) so that it will remember each invader and quite possibly resist a later—and potentially more serious—infection.

Most vaccines take a tiny protein from an invader (either a bacteria or a virus) and present it to your child's immune system for later protection. This is far less stressful than having millions of staph bacteria set up shop in your child's nose, but anti-vaccine activists continue to propose spacing between vaccines in order to have a supposed "gentler effect" on the immune system of a child.

The dangers of alternative vaccine scheduling proposals are numerous, and it's important to understand them:

• Delaying any vaccine is an obvious risk. The longer you wait to protect your baby against sickness, the higher her chance of contracting or developing an illness.
• Vaccine schedules are well studied, both in their safety and their effectiveness. Break out of that routine or proposed schedule and you are taking a chance with your child's health. You are setting a schedule that has not been studied in large numbers of children, and there may be some unforeseen problem with the invented schedule that puts your baby at risk.
• New vaccine schedules are complicated. Generally, I know exactly what vaccines I will administer to a four-month-old infant before I walk into a room. When I'm presented with an invented schedule, I check it, my nurse checks it, and then we both double-check it, but still there is more room for error than usual. Any extra layer of complexity creates an increased possibility of medical error: Vaccines may be missed or poorly timed, or they may be administered twice despite a clinician's best effort.
• Splitting vaccines and spreading them out creates the need for more doctor visits. I take pride in the cleanliness of my office, but as a pediatrician, I attract some pretty sick visitors on a daily basis. Consider the risk of exposure when you bring your infant into an office for far more than the usual number of visits in order to accommodate a more complicated vaccine schedule.