Vaccination FAQs

We would like to thank our friend and colleague, Dr. Ari Brown, co-author of the best-selling parenting books, Baby 411 and Toddler 411, for allowing us to reproduce some of the more common vaccine FAQ’s found in her books.

As many vaccine questions revolve around the concern surrounding autism and other developmental disorders, a majority of the FAQ’s seen below will address this topic. If any other questions exist, please feel free to discuss with one of us at Boulevard Pediatrics.

Question: Have the docs at Boulevard Pediatrics vaccinated their own children?

Absolutely. We all believe vaccinations help promote a healthy child.

Question: I know what the traditional immunization schedule involves, but are there any variations we can follow?

While all of us here at Boulevard Pediatrics strongly believe in the benefits from vaccinating, we certainly want our parents to feel comfortable as well. So the best way to respond to this is to bring in your concerns and questions about the schedule and let’s discuss it.

Question: I’ve heard autism is on the rise. Why?

The first question we have to ask is, do we really have an epidemic or are more children just being diagnosed? Is it better detection due to better awareness? Are we displacing one diagnosis for another? Here are some explanations for the large rise in autism:

  1. Displacing one diagnosis for another. In previous generations, many children were diagnosed with mental retardation, schizophrenia, or some other psychiatric disorder. Today, many of these same kids are diagnosed with severe autism. For example, in 1996, 1 in 63 kids were diagnosed with mental retardation (measured by an IQ score of under 70). Yet, in 2000, that number DROPPED to 1 in 83. Why? Were there suddenly much fewer kids with mental retardation? No, many of these kids are now diagnosed with autism instead of mental retardation. In other words, autistic kids were there in the 80’s and 90’s — we just didn’t call them autistic. In 1991, the Individuals with Disabilities Education Act (IDEA) required children with developmental disabilities receive school services and be integrated into a mainstream classroom setting as much as possible. Autism was added as a new diagnosis for which a child could be eligible to receive educational services. In 1993, two years after this code was added, the Department of Education reported a 23% rise in autism. Prior to the coding change, kids with autism were often labeled with non-specific developmental delay, brain dysfunction, or mental retardation.

  2. Changing criteria, broader diagnosis. The definition of autism has changed over the years. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the authoritative bible for psychiatric disorders in the U.S. The first two editions never even listed autism as a disorder. Dr. Leo Kanner first diagnosed autism in the 1940’s. Yet it was not until 1980 when psychologists recognized autism. That’s when the DSM for the first time listed criteria for diagnosis of autism. The autism diagnosis broadened again in 1994 when several more disorders were officially added to the DSM: Pervasive Developmental Disorder (PDD), PDD-NOS (not otherwise specified), Asperger’s Syndrome, Childhood Disintegrative Disorder, and Rett’s Disorder. By expanding the definition of autism, suddenly many more kids were declared autistic. Case in point: looking at recent autism diagnoses, up to 75% of these kids are high-functioning children with PDD-NOS or Asperger’s. Unfortunately, many states don’t break out where kids are on the autism spectrum. California’s autism rate is often cited in the media as example of the “autism epidemic” — yet California doesn’t specify where kids are on the autism spectrum, so it’s hard to get solid numbers. Not long ago, kids who were smart but socially awkward had no diagnosis. Today, those kids are often diagnosed with Asperger Syndrome.

  3. Better awareness, better and earlier diagnosis. Popular diagnoses rise and fall like skirt lengths. Think about it — ten years ago, had you ever heard of Restless Leg Syndrome? When it comes to autism, this newfound awareness is actually a positive step. More people — parents and doctors alike — are on the lookout for children with autism. Making a diagnosis and starting therapy earlier in life improves kids’ long term outcomes. But it also looks like autism is on the rise. Why? Because kids were previously diagnosed with autism after age five or six. Today, kids are diagnosed as early as 18 months of age. This adds many more kids to the rolls.

  4. Why does the U.S. have so many autism cases? Autism is not just an American disease — it happens worldwide. But why do the U.S. and United Kingdom have such high autism rates? That’s because the U.S. and U.K. have done the lion’s share of research and studies into autism. Other countries are just starting to look into autism. For instance, in South Korea, kids are diagnosed with Reactive Attachment Disorder (RAD) — which is really what we call Autism Spectrum Disorder (ASD) here in the U.S. We suspect that South Korea will report an alarming rise in autism when they figure out their RAD kids are the same as our ASD kids. And counting autistic kids is a relatively recent phenomenon. Before recent legislation led to schools labeling more kids as autistic, researchers just looked at either medical or school records to determine autism rates. This was imprecise to say the least.

  5. Prevalence vs. Incidence. If you’ve ever taken a statistics class (or tried hard to forget anything you learned if you did), here is a little review. Most of what we know about autism rates are based on prevalence studies: these are a sampling of a population at one point in time used to estimate overall rates. By contrast, incidence studies identify the ACTUAL number of autism cases over a period of time. The only way to know if autism is really an epidemic is to see a rise in the incidence of autism. Unfortunately, there are very few incidence studies of autism. That’s because it is extremely difficult to do this research. Only one incidence study on autism is available — that 2005 report found that rates of PDD in the 90’s were unchanged. So even though PREVALANCE studies seem to show autism is increasing, the incidence proof is lacking.

  6. Social acceptance. We’ve come a long way since autism was first identified as a disorder. Originally, experts thought autism was caused by poor parenting — namely, the mother. These “Refrigerator Moms” were blamed for rejecting their kids, causing the kids to have social problems. Of course, this was WRONG. What we’ve learned over the past 70 years is that autism is not the mom’s fault. But in the old days, no mother wanted their kid labeled autistic since that would imply HER guilt. Today, we realize it is not mom’s fault — and thus parents are more willing to accept an ASD diagnosis. And the diagnosis now allows for special education services, which many parents realize can help their child.

  7. Over or misdiagnosis? There is so much awareness now of Autism Spectrum Disorders, that perhaps clinicians are over diagnosing it. One reputable study suggests that kids who actually have anxiety disorders, obsessive compulsive disorders, and personality disorders may be misdiagnosed now with ASD. These are possible explanations for the “autism epidemic” — but we don’t have all the answers yet. The bottom line: in the 1980’s, one in 10,000 kids were diagnosed with autism. Today, it’s one in 150. The U.S. is not the only country seeing this trend. Australia, Canada, Denmark, Finland, Iceland, Japan, and Sweden also report a disconcerting rise.

Question: So what causes autism?

The million-dollar question. There appear to be four chief suspects:

  1. Genetics. We know genetics plays a role. Studying twins is an obvious way to detect genetic disorders. If one identical twin has autism, up to 96% of the time, so will the other twin. And siblings of ASD kids have a 5% risk of having an autistic disorder. To date, the exact gene has not been identified, but it may reside on the X chromosome, which may explain the prevalence of autism in boys. In fact, there is a genetic syndrome (called Fragile X) that is one known cause of autism. In 2008, researchers identified a specific gene in some kids with autism. This gene is involved in controlling brain cell communication. It appears that some kind of mutation in this gene causes a risk of autism within families. Other researchers have found abnormalities on chromosomes of autistic kids. Hence it appears that autism is caused by several different genetic defects, although researchers haven’t quite figured out the puzzle yet. One study has shown that dads over the age of 40 have SIX times greater risk of having a child with an autistic disorder than dads who are younger than 30. Hence, autism has eerie echoes of Down Syndrome, a genetic defect that is more common when a mother has “advanced maternal age” (over age 35). All of these studies show that genetic defects are a strong suspect in autism.

  2. Abnormal brain growth. Although the cause is unknown, autistic children have problems with brain growth. Babies are born with immature brains that grow rapidly and make nerve connections called synapses — like an information superhighway. In the normally growing brain, some branches of this superhighway get “pruned.” In the autistic child’s brain, the pruning process is defective. This may explain why babies with autism have abnormally rapid head growth under one year of age. Boys with ASD seem to have higher levels of hormones (insulin-like growth factors), which may contribute to the larger head size, weight, and body mass index.

  3. Environmental trigger. Is there some environmental exposure that sets off abnormal brain development in a genetically predisposed baby? Maybe. And that exposure may happen at or shortly after conception — before a mother even knows she is pregnant. There is a critical period of fetal brain development that occurs at 20-24 days after conception where the brain is most sensitive to injury. Here are just a few theories that scientists are exploring as a cause for autism: flu exposure during pregnancy, and folic acid levels in dad-to-be’s sperm (possibly a too-high level can lead to problems). Studies done by the Environmental Working Group have found about 280 environmental toxins in umbilical cord blood — could one of these be a trigger? There is also a growing body of evidence that newborns who are later diagnosed with ASD already have abnormal levels of certain proteins in their brains. So, having an environmental trigger in the womb during a critical period of brain development seems a plausible explanation for autism. What about vaccines? There has been much talk about this theory, specifically that trace amounts of mercury used as a preservative in many vaccines prior to 2001 caused a spike in autism. But the scientific evidence does not support this theory. Research during the past ten years has taken a long hard look at vaccines and found conclusive evidence that vaccine exposure is NOT the turn-on switch for autism. And no, despite what you might read online from fringe groups or plaintiff lawyers, there is no conspiracy among pharmaceutical companies to inflict autism on unsuspecting children. The Centers for Disease Control have long term studies underway to examine vaccines and autism. The most recent results, published in the New England Journal of Medicine, showed that the mercury preservative previously present in vaccines had no significant effect on either intelligence or developmental delays in kids ages 7 to 10. The results of the CDC’s study on mercury preservative and autism specifically will be published after this booklet goes to print. Stay tuned on our website for updates.

  4. Premature birth. A previous study in the journal, Pediatrics, found that premature babies born at 25 to 26 weeks gestation have a 25% chance of developing an autism spectrum disorder.

    Bottom line: Researchers don’t know what causes autism, although the above factors provide clues. The goal is to find a way to PREVENT autism — but we aren’t there yet.

Question: Did the mercury in vaccines cause autism?

No. Here is the scientific evidence: The Institute of Medicine spent four years studying this issue. Their conclusion, issued in 2004: mercury preservatives in vaccines did NOT cause autism — and the Institute said it was time to move on to look at other possible causes. Several other leading medical organizations (both nationally and internationally) agree with this conclusion. Mercury preservative (thimerosal) was removed from vaccines in the U.S. in 2001, but the rates of children being diagnosed with autism are still skyrocketing. A survey of autism rates in California in 2008 confirms that mercury is out and autism rates are still going up 13. If thimerosal was the cause of autism, and it was taken out SEVEN years ago, autism rates should be going down by now. That’s because autism spectrum disorders are usually diagnosed by three years of age. Mercury preservatives were removed from vaccines in Denmark in 1992. Canada and the European Union have followed suit. Their autism diagnosis rates are still going up, too. Mad Hatter’s Disease (mercury poisoning) and autism are very different disorders, as discussed above. A study of 100,000 kids in England compared those receiving mercury-containing vaccines to those who did not. The ones who had the mercury-free shots had HIGHER rates of autism. A study in 2007 showed that children between seven and ten years of age who got those mercury containing vaccines (before 2001) had no significant differences in tests of attention and processing information. Although the study did not look specifically at autism, it showed that mercury preservatives did not make much of an impact on brain functions in general.

Question: Do vaccines still contain mercury? What about the flu vaccine?

In 2001, the FDA required manufacturers to discontinue using mercury preservative for ALL routine childhood vaccines. Period. Many vaccines, like measles mumps and rubella (MMR), have NEVER contained mercury preservatives. Nor is mercury used in the production process for MMR. However, there are four vaccines on the market that still use mercury preservative in the manufacturing process — the mercury is then REMOVED from the final vaccine. Because the flu vaccine is considered optional, some manufacturers continue to make multi-dose vials of flu vaccine with mercury preservative. However, there are other flu vaccines that are FREE of mercury preservatives — and many pediatricians give these shots for children. Let’s do a reality check here: a tuna sandwich has FIVE TIMES more mercury than one dose of flu vaccine. As a doctor, I am much more concerned about mercury exposure in the environment — particularly in food (like that tuna fish sandwich). So if you are worried about mercury exposure, consider this: there’s mercury in breast milk. A baby gets 25 times more mercury by breastfeeding for six months than in a single dose of flu vaccine. Breast milk contains between 1.4 and 1.7 micrograms of methyl mercury per liter. If you assume that a baby is breastfed exclusively up until six months of age, that baby will consume about 360 micrograms of methyl mercury. That’s twice the amount of mercury that was ever contained in vaccines and 25 times the quantity of mercury contained in the influenza vaccine.

A quick chemistry lesson: certain compounds have completely different properties even though they have similar sounding names. For instance, there are TWO types of mercury: methyl mercury and ethyl mercury. The type of mercury that has raised health concerns is methyl mercury. Methyl mercury is a small molecule that can get into the brain and takes almost TWO MONTHS to break down. High concentrations of methyl mercury can be found in tuna, swordfish and shark from contaminated waters. Now, let’s contrast that with ETHYL mercury, which is/was the type of mercury used in vaccine preservatives. Ethyl mercury (thimerosal is an example) is rapidly eliminated from the body within a WEEK. Compared to methyl mercury, ethyl mercury is a much larger molecule that cannot enter the brain. Ideally, it would be nice to remove ALL mercury preservatives from flu vaccines — so we could put this controversy to rest. The problem: at this time, the only way to manufacture the huge quantity of flu vaccine needed each year requires using mercury preservatives. Hopefully, vaccine makers will figure out a way to eliminate mercury from all vaccines in the future — so any concerns can finally be put to rest.

Question: Didn’t the government previously concede that vaccines caused autism?

As you may have heard on the news at the time, the government decided to compensate a child whose autism was allegedly triggered by a vaccine. Here’s the background behind the headline: The Vaccine Injury Compensation Program has been holding special hearings called the Omnibus Autism Proceedings. This “Vaccine Court” is looking at allegations that 4900 children developed autism from vaccines. The court is first looking at nine cases to form opinions about the evidence. One child, Hannah Poling, was awarded a monetary settlement. Hannah was born with a rare genetic disorder (mitochondrial disorder, which is a dysfunction in basic cell metabolism). This is the equivalent of being born with an undetected heart defect — a ticking time bomb that could go off at any time. For rare kids like Hannah, any stress could have caused her to develop autism. In fact, having a vaccine-preventable disease like the flu or chickenpox could have far worse health consequences — a disease like that could have killed her. Although she was not diagnosed prior to being vaccinated, experts recommend that even children with known mitochondrial disorders still be vaccinated. So even though the headlines screamed that (in this case) a vaccine caused autism, the facts of the case show this isn’t true. Hannah’s underlying disease caused her deterioration and autism. The case was settled and determined that it did not represent a test case for the 4899 other children. Experts on mitochondrial disorders do NOT think this disease is the “smoking gun” that triggers autism. That’s because many folks have similar dysfunctional cells but never become autistic. And there is no simple test for mitochondrial disorders. Instead, you must do a difficult and painful muscle biopsy and a spinal tap. As a result, testing all kids for mitochondrial disorders is not necessary, ethical or practical. And even if your child is diagnosed with a mitochondrial disorder, the recommendation is still to vaccinate.

Question: Does the MMR vaccine cause autism?

One small study of only eight patients in 1998 led a British research group to conclude that the combination MMR vaccine might cause autism. But in March 2004, after questions were raised about the study, ten of the 13 researchers of the study withdrew their claim of having found a possible connection between MMR and autism. They said, “In this paper, NO CAUSAL LINK was established between MMR vaccine and autism as the data were insufficient — now is the appropriate time that we should together formally retract the interpretation of the data suggesting a link.” Numerous major studies (at least 17 so far) since 1998 also soundly refute this alleged link. The most prominent: the Institute of Medicine’s 2004 report clearly dispelled any link between MMR and autism. Perhaps the most compelling argument that the MMR vaccine does NOT cause autism is Japan — in 1993, that country stopped using the combination MMR vaccine. Instead, Japanese children were given three separate shots for these diseases. Despite this change, autism rates in Japan continue to rise. The hysteria surrounding the MMR vaccine and the false 1998 report did have one serious consequence in England: a sharp rise in measles, mumps and rubella after parents stopped giving their kids the vaccine. In 2004, only 40% of children in the U.K. were vaccinated against MMR. And look at the rise in cases of mumps:

1995: 1936 cases of mumps
2003: 4265 cases
2004: 15,503 cases

And remember, autism rates are rising in the U.K. as well. So, now they’ve got both autism AND vaccine-preventable diseases. It’s a lose-lose battle — and the casualties are kids. Here’s the bottom line: as a doctor who sees a large volume of kids, I have never seen a perfectly normally developing kid walk into my office, get his MMR vaccine and come back next week with autism. It doesn’t happen.

Question: Are we giving too many vaccines today, too soon?

More vaccines are actually a GOOD thing! Every new vaccine protects more kids from getting sick, expensive hospital stays, and perhaps death or permanent injury. More kids are prevented from devastating diseases than ever before, thanks to vaccines. What about getting several shots at once? Is that dangerous? Could you overload a child’s immune system with these vaccine germs? Look at it this way: your child is exposed to thousands of germs on a daily basis (even if he is not in daycare). Exposing your child to five or eight different germs in the form of vaccines is a spit in the bucket. And young kids have a better immune response to vaccines than older children and adults. Before a vaccine is approved for use by the government, its safety is extensively studied. These studies look at how kids respond to the vaccine. And so-called “combo” vaccines that incorporate several shots at once also consider the combined effect. Even if your child got 11 shots at the same time, he would need to use only about 0.1% of his immune system to respond to the vaccines.

The goal is to protect your child as quickly as possible from diseases that are very dangerous to young children. And even though the number of shots has gone up, the actual load on the immune system has gone down. That’s because today’s vaccines are “smarter” and better engineered than the shots from a few decades ago. Case in point: whooping cough. Before 1991, the whooping cough vaccine had 3000 different germ particles (antigens). Today’s whooping cough shot has just three to five particles — just as effective, but much better designed to be easy on your immune system. Before 1996, the polio vaccine was “live” — this carried a small risk of actually getting polio. Today’s polio vaccine is dead (inactivated) and carries NO chance of getting the disease.

So, here’s the irony: YOUR parents took a much greater risk when getting vaccinated back in the 50’s, 60’s and 70’s. Today, even though we have many more vaccines, the risk is much lower. Our children are really getting smarter, safer vaccines today and better protection than we ever got as kids.

Bottom line: Vaccines do not weaken the immune system, they boost it.