Childhood Immunization Controversies: What Are Parents Asking?

Preventive care is the cornerstone of pediatrics, and vaccination represents one of the most important strategies in the prevention of disease in children.2 The reduction in morbidity and mortality over the past century as a result of routine childhood immunizations is quite dramatic. Smallpox has been globally eradicated, while diseases such as diphtheria, polio, and congenital rubella are virtually nonexistent in North America. Other life-threatening conditions such as measles, Haemophilus influenza type b disease, and pertussis have been dramatically curtailed to the point where families no longer fear their devastating effects.

Public concern, both real and anecdotal, regarding the adverse effects of vaccines has circulated since the time of the first smallpox inoculation by Dr. Edward Jenner in 1796. In one survey, nearly 25% of parents reported their impression that children were receiving too many vaccines and felt that this could result in a weakening of their immune systems.3 Parents worry about the “pincushion effect,” as current recommendations are for 19 injections in the first 2 years of life.4 Certainly, one would expect that a biologic product administered universally would not be without adverse effects, but are these side effects overwhelmingly mild and transient, or can chronic disease or long-term neurodevelopmental impairment occur at an “alarmingly high rate” as reported in the lay press?5–7 Over the past generation, as pediatricians have seen a marked reduction in acute invasive bacterial disease as a direct result of immunizations, certain noninfectious chronic diseases that present in infancy have attracted increased attention. “Given the close temporal relationship between frequent immunizations and the onset of certain chronic childhood illnesses, it is not surprising that speculation and epidemiologic studies have attempted to link chronic disorders of childhood to immunizations … postulated links to the increased incidence of autism … have been particularly contentious.”