Medicine:Alternative vaccination schedule

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An alternative vaccination schedule (or alternative childhood immunization schedule)[1] is a vaccination schedule differing from the schedule endorsed by the Advisory Committee on Immunization Practices (ACIP).[1] These schedules may be either written or ad hoc, and have not been tested for their safety or efficacy.[2][3] Proponents of such schedules aim to reduce the risk of adverse effects they believe to be caused by vaccine components, such as "immune system overload" that is argued to be caused by exposure to multiple antigens.[4] Parents who adopt these schedules tend to do so because they are concerned about the potential risks of vaccination, rather than because they are unaware of the significance of their benefits.[5]

Effects

Contrary to the claims made by some advocates of alternative vaccine schedules, there is no scientific evidence for the existence of "immune system overload". In addition, the amount of chemicals in vaccines such as aluminum and formaldehyde is much lower than natural exposure levels.[4] Intentional deviation from the ACIP's schedule leaves children vulnerable to infection and increases the likelihood of outbreaks of vaccine-preventable diseases.[6] These schedules also increases the risk of children who cannot be vaccinated, or did not increase the financial costs to patients, since they require the use of more expensive single-antigen vaccines and additional office visits.[7] They also increase the chances of infection among individuals who could not be vaccinated for medical reasons, because they were too young, or did not develop a sufficient immunologic response to the vaccine.[8]

Popularity

An increasing number of children are undervaccinated, of whom an estimated 13% or more are believed to be so because of parental choice.[9] One survey, published in Vaccine, found that 9.4% of parents in King County, Washington used an alternative vaccine schedule,[1] while another survey found that more than 1 out of 10 parents of children aged between 6 months and 6 years used an alternative vaccine schedule.[10] In a 2011 survey of Washington State pediatricians, 77% of them reported that their patients "sometimes or frequently" asked for alternative vaccination schedules.[11] The same survey found that 61% of pediatricians were comfortable with using such a schedule if a parent asked for it.[11] A 2012 survey found that the percentage of shot-limiting children—defined as children who received no more than two vaccines per visit between their birth and the age of nine months—had increased from 2.5% to 9.5% in Portland, Oregon .[12][13] Even pro-vaccine parents often tolerate other parents' decisions to adopt alternative vaccine schedules.[14]

Proponents

Among the most prominent proponents of alternative vaccination schedules are Stephanie Cave and Robert Sears.[12] Sears has been criticized by Paul Offit for what Offit states is Sears' "misrepresentation of vaccine science."[15]

Types of schedules

A 2016 study identified five different types of alternative vaccine schedules: Dr. Sears' schedule, a shot-limiting schedule, selective delaying or refusal, making vaccine decisions visit-by-visit, or refusing all vaccines.[16]

See also

References

  1. ↑ 1.0 1.1 1.2 Opel, Douglas J.; Banerjee, Ashmita; Taylor, James A. (October 2013). "Use of alternative childhood immunization schedules in King County, Washington, USA". Vaccine 31 (42): 4699–4701. doi:10.1016/j.vaccine.2013.08.036. PMID 23981431. 
  2. ↑ Opel, Douglas J.; Marcuse, Edgar K. (1 March 2013). "The Enigma of Alternative Childhood Immunization Schedules". JAMA Pediatrics 167 (3): 304–5. doi:10.1001/jamapediatrics.2013.786. PMID 23338852. 
  3. ↑ Boom, Julie; Cunningham, Rachel (2014). Understanding and Managing Vaccine Concerns. Springer. pp. 8–9. https://books.google.com/books?id=9z0qBAAAQBAJ&pg=PA8. 
  4. ↑ 4.0 4.1 Jackson, Michael L. (April 2013). "Challenges in comparing the safety of different vaccination schedules". Vaccine 31 (17): 2126–2129. doi:10.1016/j.vaccine.2013.02.054. PMID 23470238. 
  5. ↑ Healy, C. Mary; Montesinos, Diana P.; Middleman, Amy B. (January 2014). "Parent and provider perspectives on immunization: Are providers overestimating parental concerns?". Vaccine 32 (5): 579–584. doi:10.1016/j.vaccine.2013.11.076. 
  6. ↑ Nadeau, Jessica A.; Bednarczyk, Robert A.; Masawi, Munyaradzi R.; Meldrum, Megan D.; Santilli, Loretta; Zansky, Shelley M.; Blog, Debra S.; Birkhead, Guthrie S. et al. (January 2015). "Vaccinating My Way—Use of Alternative Vaccination Schedules in New York State". The Journal of Pediatrics 166 (1): 151–156.e1. doi:10.1016/j.jpeds.2014.09.013. PMID 25444525. 
  7. ↑ Wheeler, Marissa; Buttenheim, Alison M (27 October 2014). "Parental vaccine concerns, information source, and choice of alternative immunization schedules". Human Vaccines & Immunotherapeutics 9 (8): 1782–1789. doi:10.4161/hv.25959. PMID 23900266. 
  8. ↑ Siddiqui, Mariam; Salmon, Daniel A; Omer, Saad B (1 December 2013). "Epidemiology of vaccine hesitancy in the United States". Human vaccines & immunotherapeutics 9 (12): 2643–2648. doi:10.4161/hv.27243. 
  9. ↑ Glanz, Jason M.; Newcomer, Sophia R.; Narwaney, Komal J.; Hambidge, Simon J.; Daley, Matthew F.; Wagner, Nicole M.; McClure, David L.; Xu, Stan et al. (1 March 2013). "A Population-Based Cohort Study of Undervaccination in 8 Managed Care Organizations Across the United States". JAMA Pediatrics 167 (3): 274–81. doi:10.1001/jamapediatrics.2013.502. PMID 23338829. "In our cohort, we also estimate that approximately 13% of children were undervaccinated because of parental choice, which aligns with other published estimates of 10% to 25% from cross-sectional survey and population-based ecologic studies. However, this likely represents an underestimate of the true prevalence of intentional undervaccination and alternative vaccination schedules.". 
  10. ↑ Dempsey, AF; Schaffer, S; Singer, D; Butchart, A; Davis, M; Freed, GL (November 2011). "Alternative vaccination schedule preferences among parents of young children.". Pediatrics 128 (5): 848–56. doi:10.1542/peds.2011-0400. PMID 21969290. 
  11. ↑ 11.0 11.1 Wightman, A; Opel, DJ; Marcuse, EK; Taylor, JA (December 2011). "Washington State pediatricians' attitudes toward alternative childhood immunization schedules.". Pediatrics 128 (6): 1094–9. doi:10.1542/peds.2011-0666. PMID 22123877. 
  12. ↑ 12.0 12.1 Robison, S. G.; Groom, H.; Young, C. (18 June 2012). "Frequency of Alternative Immunization Schedule Use in a Metropolitan Area". Pediatrics 130 (1): 32–38. doi:10.1542/peds.2011-3154. PMID 22711719. 
  13. ↑ Seaman, Andrew M. (18 June 2012). "More Oregon kids on "alternative" vaccine schedules". Reuters. https://www.reuters.com/article/2012/06/18/us-oregon-vaccine-idUSBRE85H08D20120618. Retrieved 7 February 2015. 
  14. ↑ Wang, Eileen; Baras, Yelena; Buttenheim, Alison M. (November 2015). ""Everybody just wants to do what's best for their child": Understanding how pro-vaccine parents can support a culture of vaccine hesitancy". Vaccine 33 (48): 6703–6709. doi:10.1016/j.vaccine.2015.10.090. PMID 26518397. 
  15. ↑ Offit, P. A.; Moser, C. A. (1 January 2009). "The Problem With Dr Bob's Alternative Vaccine Schedule". Pediatrics 123 (1): e164–e169. doi:10.1542/peds.2008-2189. PMID 19117838. 
  16. ↑ Saada, A.; Lieu, T. A.; Morain, S. R.; Zikmund-Fisher, B. J.; Wittenberg, E. (7 September 2014). "Parents' Choices and Rationales for Alternative Vaccination Schedules: A Qualitative Study". Clinical Pediatrics 54 (3): 236–243. doi:10.1177/0009922814548838. 




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