• Diptheria
• Tetanus
• acellular Pertussis

• Pertussis is serious in infants. 

1. Diptheria is basically non-existant in the US (Fisher).  Diptheria is treatable. 
2. Diptheria is rare in children 0-6 months old, more common ages 2-5 (Fisher).
3. Pertussis incidence is currently independent of vaccination rate (CDC).
4. Pertussis is often milder in adults.  Childhood cases confer almost permanent immunity. (Fisher)

Pertussis vaccine only licensed for kids 6 weeks - 6 years (CDC same article).
5. Tetanus is not likely without puncture wounds.  Bacterial in the soil (not contagious).
6. Receive Tetanus Immunie Globulin (TIG) if have a serious wound & have less than 2 previous injections of tetanus toxoid.
7. Would rather fight the diseases than side-effects of the vaccine that are accepted/treated as "normal" (i.e., not treated).

Tetanus vaccination when Mia is older (and mobile).
=> Age 2

• Measles
• Mumps
• Rubella

• MMR has been implicated with Autism (Lancet 1998, Wakefield et. al.).
• Measles in teenagers or adults (or very young children) can be much more severe with serious complications and increased mortality (Fisher).
• Rubella vaccine can cause joint disease (arthritis).
• Rubella vaccine has significant side-effects (Neustaedter) - arthritis, central nervous system disorders.
• For a pregnant female, rubella increases the chance of infant deformities by ~25%.
• For an adult male, mumps has a small but significant chance of causing sterility.
• Mumps has more complications for adults (Neustaedter).
• MMR is not FDA approved, and is known to be unsafe for use in adults (CDC).

1. Link between autism and MMR is not statistically significant.
2. Contracting measles is believed to stimulate the immune system, providing lasting immunity.
3. Legal basis for no vaccinating is clear (www.rubella.net article)
4. "After revaccination, most reactions should be expected to occur only among the small proportion of persons who failed to respond to the first dose. " (CDC).
5. A Mother who has had measles passes immunity to her newborn for ~1year (so it would be beneficial for Mia to actually have the disease).

No more MMR for Aidan.

But it can't be given later -- are any of the diseases worse as she gets older?  (i.e., measles, rubella -- vaccinate selectively during the teenage years, after an antibody test for measles, rubella??)  Can it be given as an adult??

What about Aidan not getting the 2nd in the series (since he had a reaction to the 1st)?  Less likely to react (CDC)?

• Approximately 1% of wild polio infections cause permanant damage.

1. Polio is non-existent in the western world, and may soon be eradicated from the entire planet.

Mia can choose it later should she decide to travel to a foreign county where polio is present.

What about Dave traveling -- does it significantly increase the family's risk of polio?  (Ans: yes, but just puts Mia in one of the higher risks groups that overall has a negligible risk...)

How effective is the 4-course IPV versus the reaction risks? (does it confer long-term immunity?)

• Haemophilus influenza (type B)

• 5-10% mortality rate even with treatment (Fisher).
• The peak incidence of meningitis in children is 6-7 months of age; 50% of cases in children are at under 1 year (Neustaedter).
• Causal relationship between vaccine and type-I diabetes likely (bmj.com study) or NOT LINKED AT ALL... (bmj.com study).

1. Vaccine is not effective -- 50% of cases occur in a vaccinated person (Fisher).
2. Neustaedter claims (p 69) that the conjugate vaccine's protective efficacy is actually -58%! (more likely to get it if vaccinated...)
3. Vaccine introduction in 1985 was highly effective [1:200 children contracted invasive HIB then], is now approaching saturation (CDC).
4. CDC recommends HIB combined with DTP (CDC).
5. Dr. Kamsler said there was some evidence that the rate of HIB meningitis was decreasing, but that the total rate was not (i.e., other cases of bacterial meningitis were "filling in" the gap) -- but that other studies indicate that the total rate *is* decreasing...

When would we start? (Ans: anytime, but # of recommended doses varies from 1-4 depending on age since risk of complications declines to negligible at xx months (24??) )

• Hepatitus B

• Small risk of complications for adults with damaged immune system. For children, probability of serious adverse reaction is smaller than (5.e-7) (CDC).
• Probability of contracting fatal disease smaller than (1.e-5) (calculations)
• Predominant risk is for infants of HEP-B positive mothers, during delivery.

1. We have no known HEP-B in our family.
2. General vaccination risk is larger than specific risks.

Is there any effective treatment at the time of a blood transfusion for an unvaccinated child??

• Small risk of complications for those with damaged immune system.
• Risk of death in normal children is 0.0014% (Neustaedter, p. 75)

1. This is a routine childhood disease.
2. Vaccine is new (1995?), so relatively less is known about long-term effects, adverse reactions, efficacy.

• certain pneumococcal bacteria can cause meningitis and blood infections

1. magazine ad detailing the Northern CA Kaiser Permanente Efficacy Trial (17,066 infants) - 162 ER visits, 24 hospitalizations within 3 days of a dose
2. Aidan and Mia are not particularly at risk for complications from these diseases
3. The vaccine is too new to really know the risks (wasn't recommended for Aidan in '98...)