Medical Edge Newspaper Column

Choosing to Omit Recommended Vaccines Can Be a Missed Opportunity to Prevent Illness

November 18, 2011
Dear Mayo Clinic:
As parents, how do we know which vaccines are mandatory and which ones we have an option to choose for our children?

Answer:
Although a series of immunizations is recommended for all children, the United States government does not require immunizations for civilians. Each of the 50 states has vaccine requirements for children attending day care, school, and sometimes college. These vary from state to state. Employers may also require vaccinations for their employees.

Among the U.S. recommendations for routine vaccination, none are considered more important or recommended more than others. The Centers for Disease Control and Prevention (CDC) brings together a group of volunteer experts that include scientists, physicians, and public health officials to develop recommendations about routine vaccinations. This group, the Advisory Committee on Immunization Practices, or ACIP, develops nationwide standards for vaccinations. ACIP's work is endorsed by several professional medical groups that support and follow ACIP recommendations, including the American Academy of Pediatricians and the American Academy of Family Physicians.

When a parent brings a child to Mayo Clinic and asks what vaccinations that child should get, we base our answers on the ACIP recommendations. The members of the ACIP are a carefully selected group of highly qualified experts who have access to all the data available to support the wisest choices about what's effective, safe, and makes good health sense for the nation's children. Of course, doctors do not have to follow those recommendations. Doctors can choose to adapt the ACIP recommendations to fit each patient's needs. But, in general, most health care providers, including those at Mayo Clinic, abide by the ACIP recommendations.

Currently, the list of routine immunizations recommended by ACIP includes those that protect against rotavirus, polio, Haemophilus influenzae type b, measles, mumps, rubella, diphtheria, tetanus, pertussis and chickenpox. The pneumococcal and meningococcal vaccines are also recommended. These can help reduce the risk of becoming infected with pneumococcal and meningococcal bacteria, which can lead to pneumonia, bacteremia (a severe blood infection) and meningitis. Hepatitis A and hepatitis B vaccines are also recommended for all children, as is the human papillomavirus vaccine. In addition, the ACIP recommends that everyone older than 6 months get the influenza (flu) vaccine every year.

These vaccines are all recommended, but none are mandatory. None are recommended more strongly than others. All are recommended at specific ages to maximize the usefulness as well as the safety of the vaccines.

Although well-publicized controversies have raised questions about the safety of vaccines, evidence-based research from large clinical trials has consistently shown vaccines to be safe and effective. In fact, vaccines and the advancement of routine childhood immunization programs are arguably among the most important medical advances in history. The Centers for Disease Control and Prevention ranks vaccinations in the top 10 public health achievements of the 20th century, along with hand-washing before surgery and access to a clean water supply. Vaccinations have dramatically changed our lives, allowing us to live longer and in better health, with less disability and suffering.

Those who think we no longer need vaccines because these diseases don't happen anymore are wrong. Through routine vaccination, these diseases have "disappeared" from the public's view. But outbreaks of vaccine-preventable diseases are just a plane ride away. People who choose to delay or omit vaccines are putting their children at risk for those infections and the related complications, and may miss out on an opportunity to prevent devastating illness.

If you are unsure of the immunizations your children should get, or if you have questions about vaccines, talk to your doctor or nurse. Your child's health care provider can help you determine which vaccines are recommended by the ACIP and when your child should get them to help ensure their good health, now and in the future.

— Robert M. Jacobson, M.D., Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn.