COLUMBIA — When Candace Sall found the receipt from her daughter’s visit to the Health Department, she was upset — but not about the cost.
Sall had sent her husband to the Columbia/Boone County Public Health and Human Services Department to get their daughter, Lindsey, the vaccine for measles, mumps and rubella. When Sall’s husband discovered the department would not give Lindsey the shot unless she received all the recommended shots, Lindsey got her vaccine, along with four other recommended vaccines.
"I told him, 'You should have walked out of there without the shots, then,'" Sall said. "'I felt like you poisoned my daughter, you gave her all these shots.' There was a little fight at home for that."
Sall is one of a rising number of parents who are concerned about childhood vaccinations. She has created her own vaccination schedule instead of following the one recommended by the Centers for Disease Control and Prevention.
More than one in 10 parents of young children currently follow an alternative vaccination schedule, according to a national survey published by the American Academy of Pediatrics in the journal Pediatrics in October. Of the parents who create their own schedule, most refused certain vaccines or delayed shots after the recommended age. The most commonly refused shots were for seasonal flu and chickenpox, and the most commonly delayed shot was for measles, mumps and rubella (MMR).
Researchers also found it troubling that one in five parents who follow the recommended schedule think delaying vaccine doses is safer than allowing their children to receive them according to the suggested schedule.
"A concerning finding from our study was the large proportion of parents currently following the recommended schedule who seemed to be 'at risk' for changing to an alternative vaccination schedule," according to the study.
Many of parents’ vaccination fears stem from a study that connected the MMR vaccine to autism, though the researcher's medical license was revoked and an investigation by the British medical journal BMJ proved the study to be a fraud. Outspoken celebrities, such as actress Jenny McCarthy, and politicians, such as Rep. Michele Bachmann, have questioned the safety of vaccines and fueled parents' fears.
Trina Teacutter, nursing coordinator at the Health Department, has given vaccines to children almost daily for the past 12 years. It's clear that parents are grappling with a lot of conflicting information, she said.
"Parents hear a lot of negative things about vaccines, and even though it may not be scientifically based, I think it causes fear," Teacutter said. "They think that these vaccines are in some way going to hurt their children."
Teacutter, who is a registered nurse, is confident of the science behind the vaccination schedule. She said vaccines keep children out of the hospital and keep them from dying of diseases, and that when parents delay or reject a vaccination, their child is more vulnerable.
The idea that vaccines are harmful persists, even when science proves otherwise, said Michael Cooperstock, chief of the Division of Pediatric Infectious Disease, Immunology and Rheumatology at MU Child Health. One reason people think this way is because of what he refers to as "anti-vaccineers."
"The 'anti-vaccineers' are a small but vocal group who fervently believe vaccines are harmful," Cooperstock said. "By all standards of knowledge, the 'anti-vaccineers' are flat-out wrong. But when a typical mother hears those concerns, she may be left unsure what to think — it is not clear to her."
Many parents are worried about the number of vaccines their children receive, Teacutter said. She acknowledged there are a lot of shots given in the first two years of a child’s life. She gives shots when a child is 2 months old, then at 4 months, 6 months, 1 year and 1 1/2 years.
"The idea that the number of vaccines will overload a child’s immune system is in no way scientifically based," she said. "We know from the moment they are born, children are exposed to a huge number of organisms just in the everyday environment. So the number of antigens they are exposed to in a vaccine is really just a drop in the ocean."
There is also a perception among parents that certain diseases are not as serious, such as chickenpox, Teacutter said. But if parents stop vaccinating against diseases they don’t think are harmful, it could prompt a resurgence in the disease.
"The problem is that there are children who die from chickenpox, and if you are a parent whose child has died from chickenpox, your perception of the importance of that particular vaccine is going to be different," Teacutter said. "Because we have the chickenpox vaccine, fewer children are hospitalized."
It is flu season, but Ann Marie Long does not plan to take her 2 1/2-year-old son, Brome, to get the flu vaccine. Instead, Long is nursing him four or five times a day to help Brome fight off infections on his own.
Long thinks vaccines have their place in the world — she has had her son vaccinated three times. However, she thinks the recommended vaccine schedule entails injecting an enormous amount of artificial substances into a small, developing person. She wants to give Brome every natural defense first.
"I feel that he has enough of an immune system now and enough defenses that even if he got one of those diseases, he would be able to handle it, and I would be able to recognize the seriousness," Long said.
As a parent, Long said she is constantly assessing risk. She thinks Brome is at a lower risk of contracting diseases because she doesn’t send him to day care, keeps him in a tight community and feeds him a probiotic, nutrient-dense, low-sugar diet. The choice to vaccinate should be made based on personal research and a family's lifestyle, she said. If Long's lifestyle changed or if her family were to travel to a foreign country, she would reassess the risk.
Lifestyle and personal research also drove Columbia mother Amber Bradshaw's decision not to vaccinate her 2 1/2-year-old twins. Her family has not been in a situation yet where she thought vaccinating her children was the right choice, she said.
Bradshaw is concerned with the ingredients in vaccines, especially thimerosal, which is a mercury-containing preservative. Thimerosal exists in reduced quantities in select vaccines, but Bradshaw is not willing to take the chance.
"I feel like with something as important and potentially life changing as vaccines, I need to be informed and make the decision myself and not say, 'Oh, gosh, this person has had years of medical school, so I better just do what they say,'" Bradshaw said.
Doctors in public health can be pushy, Candace Sall said. She wants her daughter to get vaccinated at her own pace. Sall isn’t comfortable giving vaccines to a 3-month-old baby, especially when some of the shots contain aluminum.
"Public health doctors see so many people, they don’t know us personally to know we will come back and get the vaccine," she said. "You have to be able to stand up for yourself and fight for what you believe in and show them you’ve done the research and that you’re not arguing for arguing’s sake."
'Subtle shades of risk'
Elizabeth Allemann practices holistic family medicine and medical acupuncture in Columbia. She is Sall's and Bradshaw's family doctor. Allemann thinks the field of medicine is experiencing some growing pains about parents’ vaccination decisions.
During the 25 years Allemann has practiced medicine, she has noticed an increasing number of families concerned with the safety and effectiveness of vaccinations.
Parents are questioning the idea that physicians are the ones who need to make the decision, she said.
"Parents are making these decisions, and their children are the ones who will live with the consequences of the decisions," Allemann said. "If a child gets sick, whether they were vaccinated or not, it is the parent that is going to nurse the child through that illness."
Parents want to find the risk-free option, but there isn’t one, she said. Vaccines are not 100 percent effective, so there is still a chance of contracting a disease, Allemann said.
"I think people want to say things like, 'I would do that if it was safe.' People are looking for absolutes, but we live in a world of subtle shades of risk."
Allemann suggests parents decide which risks are more consistent with the values and principles that guide the rest of their lives.
"Those are the decisions that people are happy with and increase their competence and confidence as parents," she said.
For some parents, the choice is clear: The risk of the disease far outweighs the risk of the vaccine.
Deborah Intveld vaccinated her children and is glad her granddaughter will also be vaccinated. The diseases that vaccines protect against might not be as common as they once were, but they are still dangerous, she said.
"You always have concerns, but 30 years ago, they knew it was the thing to do," Intveld said. "Why would you want to take such a chance? I think you had to live through the polio era to know what polio was really like."
Columbia mother Jennifer Waggoner said she isn’t concerned because researchers have tested the vaccines before they are given to her children.
"I have a brother who is in the autism spectrum, and I don’t think it was vaccines that did it," Waggoner said. "I don’t worry about giving my children vaccinations because if you don’t, there are a lot worse things that could happen that would result in death."
She said there are only so many things parents can do to protect their children.
"Wouldn’t you want to do everything you can?" she asked. "There is a car seat, so why not a vaccination?"