It's All About the Children

Some very interesting events have occurred over the past couple of months. All of which have produced a good deal of interest, probably one more than others. And although not directly related (as I will explain below) all deeply intertwined by a theme that has become a major undertone in the pediatric population today: vaccines and autism.

Over the course of my career, I have seen the primary concern of parents evolve into the issue surrounding vaccines. I have parents ranging from those who have searched the internet for hours upon hours, to those who heard something from a friend of a friend about vaccines. I have spent many a well-child care visit discussing vaccines and been sent email after email of questions, comments, and websites regarding any related information (usually not so good).

And now everything has just been turned up a notch with the recent events. I first want to address the concession by the U.S Court of Federal Claims that the vaccines received at 19 months of age of a now 9 year old girl with a mitochondrial disorder exacerbated her underlying diagnosis as well as led to her diagnosis of autism. At this 19 month old visit, 5 injections were given (which included a total of nine vaccines with thimerosal [the mercury additive] being the preservative used in the vaccines) and within 48 hours, a high fever developed with extreme inconsolability. Shortly thereafter, this young toddler soon stopped walking and her speech digressed. Now it should be noted, it is not clear as to the extent of the underlying medical condition's impact on her development of autism but what we do know is she will now be eligible for compensation through the National Vaccine Injury Compensation Program...and, therefore, be the first child to do so with autism at the heart of the matter.

So what about these other stories I hinted at above? Well, in February of this year, a measles outbreak was confirmed in San Diego County. It appears a 7 year old unvaccinated child acquired the virus when on vacation in Europe the previous month. And last I heard, eleven additional cases of measles in unvaccinated children in San Diego have been associated with this first case. Other than one infant being hospitalized for two days, I am unaware of any further complications for any of these children but I would like to take this opportunity to remind us all of some of the more severe complications with measles and children:

1. Acute encephalitis, which often leads to permanent brain damage, occurs in proximally 1 of every 1,000 cases.

2. Death occurs in 1 to 3 of every 1,000 cases in the U.S. (often from respiratory and neurological complications).

One might think these numbers aren't too significant, but when there exists something to prevent these even remote outcomes, I would claim that these numbers are unacceptable.

Just last week at the hospital I visit nearly every day--whether it be a newborn or a child hospitalized in the pediatric ward, the first confirmed case of measles in Los Angeles County since 2006 was made public. Even though no additional cases have been identified, I believe it's only a matter of time. Furthermore, these and other cases have prompted the Centers for Disease Control and Prevention (CDC) to recommend U.S. residents 6-11 months of age should receive one dose of measles or MMR vaccine prior to any international travel.

So where does this leave us? Probably in a greater state of debate and confusion than before, as there is more fuel for both sides to justify their beliefs. To not see this would be a disservice to our children and our children‘s children. These recent cases of measles serve as a reminder to us all that in an unvaccinated community, a single case may evolve into an outbreak with minimal effort. And this court case provides some just cause that maybe something about the vaccines (possibly that some children cannot handle multiple immunizations at a single visit) needs to be reevaluated.

But I do hope we all realize that, ultimately, we have the same goal to do our best for our children. So when we speak with each other, we will do it with respect. We all have something to learn.