Book Review: The Vaccine Book, by Robert W. Sears, M.D.

There is no shortage of literature (and I use the term loosely, to encompass wackaloon websites and badly photocopied CDC info sheets from the pediatrician's office) on vaccination these days. Most of it fits the description given by Stephen Merritt to the Book of Love: "Some of it is just transcendental; some of it is just really dumb." In other words, some of it is well-researched and balanced -- even erudite -- in its presentation, and some of it is...not.

Thankfully The Vaccine Book falls more closely into the former category. I would expect no less from the Sears Parenting Library Series, which, while derided in certain circles for its overly traditional depictions of sex roles and parenting (which, bafflingly, did not trouble me in the least), is a widely available, well-respected, and (in our house, anyway) heavily thumbed-through stack of books that doesn't make me feel like a baby-smothering freak for co-sleeping (and in fact provides research to support safe co-sleeping) or a ditch-squatting om-chanting hippie for not opting for an epidural.

The Baby Book, however, did make me feel a bit outside the fringe-y norm (the norm-y fringe?) of the Sears oeuvre, when it came to vaccines. In a gentle yet firm manner, Sears Paterfamilias toes the party line. (I seem to remember that an older version of the book was somewhat more firm and less gentle, but I can't confirm that.) When I heard that a new generation of Dr. Sears was coming out with a book on vaccines -- that wasn't cover-to-cover head-patting and there-there-ing, I was intrigued. How far did this apple land from the tree?

Sears opens by proclaiming that he wrote this book because "there is no other fully informed, unbiased vaccine book available." Some would point to Aviva Jill Romm's Vaccinations: A Thoughtful Parent's Guide or Robert Mendelsohn's How To Raise a Healthy Child in Spite of Your Doctor, but I guess some would point right back at CDC factsheets or, you know, books about iridology. But I forgive him for that when he comes clean and admits that doctors "learn very little about vaccines, other than the fact that the FDA and pharmaceutical companies do extensive research...to make sure they are safe and effective. We don't review the research ourselves." (Bolding mine.) That's a big admission from someone in the medical field, although it's intuitive enough, that there's so much information flowing that medical professionals depend on indirect information from other sources. Note also that the pharmaceutical companies are conducting a lot of the research -- more on which later.

Sears then goes on to address each vaccine and disease one by one, in its own chapter. He details the symptoms, treatment, and relative seriousness of each disease, then looks at the vaccine -- how it's manufactured, what its ingredients are, are they controversial, why would someone choose not to get it. Finally he asks: should your baby get this vaccine? He gives his own answer, with explanation. There is room, generally, for one's own reasoning as well; Sears gives options for delaying or changing the vaccine schedule, choosing one company's vaccine over another's.

I'll tip the good doctor's hand and share with you the vaccines he considers least important for infants: Hep B, Polio, and varicella. Maybe influenza. (Some are not for infants at all -- HPV or meningococcal disease, for example.) There are, of course, caveats -- in certain situations he does recommend the Hep B for young children, and he mentions that from a public health standpoint the polio vaccine is a good one -- but I will admit I agree with him entirely on these points. He also recommends a varicella titer at age 11 for unvaccinated kids, since the disease can be so much more serious after that point, and that's our plan for Sophia. Additionally he makes the point that actual varicella provides lifelong immunity; the vaccine requires boosters. All good and important information. (He does caution non-varicella-vaxing parents not to freak out if their child is exposed -- which first made me laugh, because who would do that? But I've seen enough of it even on crunchy message boards that I suppose it's a necessary warning.)

So what is important? Well, all the rest. But Sears takes a very measured approach, saving his strongest words for a handful that he believes will do the most good and the least harm. He presents the option of delaying the MMR for several years, since the diseases themselves are not generally severe in childhood and complications arise more in older patients (and fetuses). He brings up the possibility of giving pertussis shots to teens and adults, which makes a heck of a lot more sense from a public health standpoint (adults don't get very sick with pertussis, but do spread it all over the place*). I don't agree with every vaccine recommendation, but I respect his reasoning. He also looks at vaccine research, and goes more in depth about the ingredients. There's a lot of information in here, but it's broken up such that you don't have to slog through citations if you want a brief overview of the relative risk of contracting tetanus.

My favorite chapter, though, is "Parents Who Delay or Decline Vaccination." Dr. Sears provides his own selective schedule (which is still a pretty heavy schedule, and includes the vaccines he deemed less important), and then discusses different strategies -- delaying until age 2, delaying until the teen years, how many shots to get at different stages (did you know that if you start MMR after age four, you need only give one shot?) Best of all, he offers precautions to take if you don't vaccinate. Stay healthy, breastfeed, avoid day care and nurseries for the first two years, watch symptoms carefully. ("If your child has a fever, don't give her a fever reducer and send her off to school" -- shouldn't that be the case for everyone? God, I wish.)

In sum: the apple must have rolled just a little bit after it fell from the tree. Sears the Younger veers from the AAP vaccine ideal significantly (the mere suggestion that parents who opt to delay vaccination ought not be placed in stocks in the town square and pelted with nag champa and bong water is downright revolutionary), but he stays near enough to the mainstream -- and maintains a respectful enough tone toward the medical profession -- that just about anyone could pick up this book and find it an informative, fascinating read. It's a book you could take to your doctor if you felt nervous about suggesting your child skip the Varivax; it's a book that could help you clarify your thoughts about vaccinating or not, and how much, and when, and why. It's a book that could make you feel less terrified of your neighbor's unvaccinated child. It's a great jumping-off place for considering the way we approach vaccination as a society, and a wonderful addition to the parenting literature.

*Whenever some horror story on the internet crops up about a vaccinated person who got pertussis from an unvaccinated child, I feel somewhere between ROFL-y and ferocious, because, man, just NO. The immunity wears off and adults go blithely around spewing pertussis droplets without even realizing they're sick with anything worse than a cold -- where did the unvaccinated child catch it in the first place? Furthermore, even people whose vaccine immunity is up-to-date can get pertussis if it's a different strain.Think of the unvaccinated child as a canary in a coal mine here. And if you're up in arms about the public health risks of pertussis, go get the vaccine yourself. I'm going to. 

Comments

[WendyP]

How timely. I'm going in on Friday for DPT and varicella vaccines after a very negative titer. I'm reserving Saturday for feeling lousy. It's so much better than getting chicken pox at age 35 or giving pertussis to some newborn. I want to do my research and be intentional when it's time to vaccinate our kids some day. Thanks for the information.

[Sarah V.]

With regard to delaying the MMR, what did he say about the herd effect? My concern about delaying the MMR would be that that way you have a pool of unvaccinated kids in whom passive immunity from the mother has worn off, and that can allow the virus to start circulating again. And while this is unlikely to be a problem for the unvaccinated kids who catch it, the problem is that there's always going to be the occasional woman who missed out on her rubella jab for whatever reason, or child who can't have the jabs because he's immunodeficient and thus is at particularly high risk from the diseases as well. That's the thing about vaccination - if you vaccinate enough people, it starts providing indirect protection for the people who don't have the jab. In the UK, we used to have rubella vaccination only for girls and only around age 12, but, because this left the virus circulating in the community, there were still cases of fetuses being affected by rubella because you never get 100% coverage of your target group and the women who'd been missed were catching it from the boys and younger children who'd never been vaccinated. I'd be interested to know what Sears says about this.

Anyway, sounds like a good read - I'll consider getting it. Thanks!

[Jo]

He does address it (although I didn't, since I'm long-winded enough as it is). Mostly to agree with you. It's a public health conundrum, ain't it?

Although I must point out that in the case of varicella, the opposite is happening -- as vaccine coverage increases, the vaccine's efficacy has dropped. This happens because some vaccines work best when the recipient is exposed regularly to the pathogen, providing intermittent "boosters." When the chicken pox incidence dropped dramatically, people stopped getting the "boosters," and then incidence *among vaccinated people* started to rise.

Isn't that interesting?

[sonya Lunder]

Thanks for the detailed and informative post. I've been curious to know where he/they would sort out. My only question, how on earth would someone justify skipping the polio vax? It seems like one of the no-brainer ones for me.

[Jo]

Well, the chances of actually contracting polio in the developed world are about nil. It's really more of an issue in the developing world -- and US kids skipping that vax aren't going to affect the kids in Africa, yk?

In addition, polio is one of those diseases that's kept at bay by sanitary water practices. So even without widespread vaccination, it's not a high risk in the US.

[Arwen]

I love Dr. Sears too. His book on high-needs children made me feel justified in the way we were handling our high-needs baby, which helped me deal with people who charged that we were making her clingy and fussy by coddling her. It makes me crazy that people consider baby-wearing, co-sleeping, and on-demand breastfeeding with an *infant* to be coddling, but that's the world we live in, and Dr. Sears gave me confidence to face it with chin held high. I will always love him for that.

Thanks for the review! We went pretty mainstream with my 16-month-old's vaccines (although we did skip the HepB) and fortunately we've seen no ill effects, but if we have another baby I'm going to do my research more thoroughly, and I'll definitely be including this book.

[anon]

I wonder that sears' antediluvian gender prescriptions don't irritate you. they made me furious and the book somehow sailed across the room into a wall.

[sherry]

Excellent post and equally excellent, in-depth review.

Just based on what you've said, I think we'll be adding that book to our Sears library as well. Even though we're pro-vaccines and have adhered to the schedule issued by our ped, it sounds like it's a decent addition to our arsenal. I LOVE being informed!!!

Thanks, Jo!

[Anonymous]

I comment here regularly but will be anonymous for this post.

I work in the pharmaceutical industry, where the pharma companies do the lion's share of the research on their own drugs, especially new ones. It's not just the vaccine data that the doctor's don't review, it's data for ALL the drugs. I have found many doctors shockingly uninformed about clinical studies, and depressingly susceptible to the propaganda put out by drug reps. For example, I went to my GP with a sinus infection, and he gave me a million samples of Zyrtec, which treats allergy symptoms I didn't have, and he told me to call him if I wanted a prescription.

I'm not sure WHY they don't review the data and draw their own conclusions. Results are published, and they should have the skills to interpret the data, or at least to recognize when a clinical study doesn't fully address all the issues.

I am not sure I take your point about the polio vax, though. The world is smaller, now, and anyone can get on a plane.

[Jo]

First anon -- why anon? Nothing to be ashamed of! :) I just have a very tough hide for that sort of thing, probably due to my upbringing. It rolls off me.

Second anon: I know, I know. It's scary. And nice to hear confirmation from someone in the industry.

About the polio -- the last case of polio in the US was in 1985 when an immigrant came with it. Even aside from the risk of spread due to world travel, it's not that common of a disease -- a couple thousand cases reported in Asia and Africa annually. Here's the really interesting thing, though -- it's only serious in about 1 out of 250 cases (with muscle weakness and paralysis). Most people wouldn't even realize they had it -- either no symptoms or a mild sore throat. The paralysis itself is usually temporary, though 2/3 of those paralyzed suffer permanent muscle weakness.

In short: low risk of contracting the disease unless you travel abroad to certain countries; low risk of suffering a serious illness even if you did contract the disease. That said, we'll do polio when Sophia is older.

[Lilian]

Thanks for this most excellent review!! For some reason, I never caught on to the vaccination fear discussions, maybe because the first time I heard about it was through a family we knew who was *extremely* conservative in all their views (and in a Christian fundamentalist way) and the book they gave me about vaccines didn't convince me at all. oh well. maybe I should have known better and thoroughly researched and thought about the issue, but now, I (we) didn't.

[erin]

I suppose we should add this one to the library. We've delayed up until now (she's newly 2) but are having a hard time deciding which ones to give. I wish*wish*wish they had a single pertussis vacc for the wee ones. That disease scares me and can be severe (and deadly) in infancy, but I can't justify the risk of the combined vacc (all that I've read indicates that brain swelling is a not-too-far-out-there possible side effect) You'd think with all the concern and negative publicity some pharmaceutical company would see the dollar value in breaking the vaccines up so we could choose to do them one at a time of we wanted...

[Jo]

Yeah, we struggled with the pertussis issue too -- most dangerous disease in small babies, yet one of the most reactive vaccines. In the end we didn't do it, and now that Phidie is 2, she's really out of the danger zone for pertussis. So she'll get the Tdap when she's older, I guess.

[Lauren]

I work for a vaccine company, and there is an unbelievable amount of work that goes into an application for FDA approval. I think that the vaccines themselves are safe, I just don't see the need to give them all at once. Spacing out vaccines gives the immune system more time to adequately respond to each one, in my opinion.
As to why the DTP is one combined vaccine instead of several, there are probably several reasons for that, the least of which being that it is a nightmare running clinical trials involving children.
Anyhoo, I've added the Sears book to my library request list, kudos for a great review!

[Emmie (Better Make It A Double)]

Great review, Jo. I might have to get this one at some point just as a family reference, even though my boys are almost 3 and we've made most of the decisions. We selectively vaxed, and we have some family who think they're going to get some "third world disease" (their choice of words) because we didn't do them all and yet more family that thinks we've risked all kind of neuro problems like autism because we did any vaccines at all. Oh, and none of them actually work, it's all just a bunch of coincidences and conspiracies. Sigh. I'm truly unconvinced of the autism/vaccine link at this point. Did the book cover the thimerosol issue?

[Jo]

Thimerosal -- yep, it did, nicely. Worth taking a look, too. (Although new studies are coming out all the time.)

Autism wasn't one of our big worries, btw.

[juliag]

Thanks, thanks, thanks!

We've been selective and now DS probably can't have some of the vaccines anyway (due to severe egg allergy). I felt better with DS having a couple of DTaP's for the pertussis, but we didn't finish the series as he reacted worse each time he got it. Our naturopath did his little question-answer thing for DS and vaccines and determined that polio and HIB seemed to be fine for him, so we did those. The only one our ped is fight us on is Prevnar...she really wants him to get it. Meh.

I am a little worried now though because we're headed to Walt Disney World and my friend who works in public health on the vaccine front says that there have been several outbreaks of things at the big theme park places. Ugh. We don't go outside our bubble much so I usually don't worry too much.... Whenever we step on a plane I get to thinking about all the vaccines we've skipped.

[lorrie]

My great grandfather's youngest brother died an agonizing death from polio in the early part of the century. I'll concede that this has absolutely zero relevance to 2008. But I never claimed to be rational; my kids got the polio shot and I would do it again.

[Kristie]

File me under not completely rational with Lorrie...

I gave my brand new baby pertussis. I started coughing two days after we came home from the hospital, and who would think of pertussis? All I could think about was how much it sucked to have a c-section incision and a horrible horrible cough.

Anyway, then he started coughing and turning sorta blue and scary stuff like that and we ended up spending nearly two weeks in the hospital. He tested positive for pertussis and they assumed that I had it, and explained about the vaccine wearing off in adulthood, and then I got to talk to some CDC people.

Anyway, I said all that to say this... Even though he was too young to have been vaccinated yet anyway, that was a scary scary two weeks, and I sort of jump up and agree to whatever vaccination the doctor offers lest he be stricken with some other Victorian disease I was not aware was possible to contract in this age. :)

[Rosie_Kate]

Longtime lurker... I just have to delurk for this one.

Thanks! I'll have to check into that book. My parents raised me on "No vaccines ever ever ever!!" But I am beginning to take a more balanced and modified view of it. This book may still be a little mainstream for me, but sounds like it has lots of good info.

[Delenda]

Thanks for the review. I would like to comment on two things. First, you said "Additionally he makes the point that actual varicella provides lifelong immunity; the vaccine requires boosters." Actually, getting varicella naturally does not guarantee lifelong immunity; like vaccine-induced immunity, maintaining "natural" immunity takes boosters - boosters that are naturally provided when varicella circulates widely in the community. Because of the decreased circulation of varicella due to the vaccine, even naturally-conferred varicella immunity can wear off. There was a nice write-up of this problem in Slate: http://www.slate.com/id/2114797/

Second, you write that "In addition, polio is one of those diseases that's kept at bay by sanitary water practices." While it is true that polio is waterborne, the surprising fact is that it was increased sanitation in the United States that led to polio's emergence as a widespread problem here in the first half of the twentieth century. In the days before clean filtered water, polio exposure was virtually universal. As Arthur Allen discusses in his book Vaccine, babies exposed to the virus were protected by maternal antibodies and by some kind of special immune response which apparently decreased with age. Polio epidemics showed up along with modern plumbing that protected babies from exposure. The result is that when children were exposed to the virus, they were unprotected. The cleaner the water got in the US, the higher the polio caseload. Not that I am recommending a return to unsanitary water, of course, but I think it's interesting that while most of us associate better sanitary practices with a decrease in disease, the opposite can also be true.

[Jo]

Delenda, fascinating! Now I want to read more.

Kristie, how terrifying! To this: "Even though he was too young to have been vaccinated yet anyway, that was a scary scary two weeks, and I sort of jump up and agree to whatever vaccination the doctor offers lest he be stricken with some other Victorian disease I was not aware was possible to contract in this age." I have to say that this is just the kind of thing where I think the public would be better served by a campaign to vaccinate ADULTS against pertussis! Because as you said, the babies most at risk are way too young for the vax, but hey, it goes all around the adult population! Who are basically untouched by the vaccine at that point!

If we can have flu shot campaigns (btw I do NOT get the flu shot, but just for the sake of example), why can't we have pertussis vax campaigns for adults?

[Kristie]

Exactly, Jo. If I had had a pertussis booster in adulthood, my son wouldn't have gotten sick. I think we totally need an awareness campaign. I mean, I didn't even know I could catch pertussis. I just thought I had a bad cough and didn't even bother seeing my doctor, just kept trying to wait it out.

I was desperately googling symptoms at 3 am, trying to decide if we were going to wait to see his ped in the morning or go to the emergency room ( because he seemed perfectly fine in between coughing spells at first) and I came across a pertussis website with sound clips and video clips of pertussis coughs. And Aha! And Whooping cough? seriously?

Now I always suggest pertussis when an adult has a bad cough, trying to be my own one woman awareness campaign, I guess, so they get treated and don't go spreading it around if they turn out to have it.

Thankfully, everything turned out fine for us. We caught it early, my son recovered fully, and is now know as "the pertussis baby" at our doctor's pracitce.

[Winifred]

Great review, I'm checking out the book even though I suspect my children will have almost-standard vaccination schedules. (Keep them out of day care!? ha.)

There are a lot of horror stories out there, but I've always been curious why we're more likely to listen to "X's child had Y complication from Z vaccine" than "X was pregnant and Y came into the office with measles!" I definitely would have included myself in this group of believers, until the second scenario actually happened to a friend of mine. (Y didn't know what his/her illness was, and X's baby was fine... but it was a Big Scare.)

[Erin]

Wait, what's wrong with the flu shot? Did I not get the memo? Or am I just too far on the norm-y side of fringe to know?