A note from a pediatrician who supports the US vaccination schedule

NOTE TO READERS: This email defending the American vaccine schedule came in the wake of the piece about the Danish vaccine schedule. I have cut it for length but am otherwise running it unedited — the writer is capable of speaking for himself.

His point of view is worth a listen. He’s a straight shooter. There’s no fake moral chest-beating or insistence on protecting grandma here, just an argument that these diseases can be nasty even if they aren’t fatal. Judge – and comment – for yourself!

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Hi Alex

After following your Substack since 2021 as a free subscriber I just purchased an annual membership. What triggered it was the recent discussion about the Denmark immunization schedule.

Frankly, I don’t see a huge difference between the Danish and US vaccination schedule [the writer then posted chart noting that the biggest differences are the lack of rotavirus and hepatitis A and B vaccines]…

According to: https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-19-rotavirus.html

Rotavirus was discovered as a cause of gastroenteritis in 1973. It caused 2.7 million infections per year and affected 95% of children by age 5. “Rotavirus infection was responsible for 410,000 physician visits, more than 200,000 emergency department visits, 55,000 to 70,000 hospitalizations, and 20 to 60 deaths annually in children younger than age 5 years. Rotavirus accounted for 30% to 50% of all hospitalizations for gastroenteritis among children younger than age 5 years; the incidence of clinical illness was highest among children age 3 to 35 months…

In my own pediatric practice the worst case I had of rotavirus infection was a child who was hospitalized for a week with diarrhea and dehydration. I have not seen a child hospitalized with rotavirus since the vaccine was introduced.

Based on the reduced morbidity alone I would support the use of the Rotavirus vaccine. Denmark appears to have applied a “severe complication” standard and have decided not to approve its addition to the routine vaccine schedule.

Interestingly nearby neighbors, Finland, Norway and parts of Sweden do recommend the rotavirus vaccine.

With the introduction of the varicella vaccine in the US in 1995 and a 2^nd dose in 2007 the incidence of chickenpox has plummeted. As a secondary benefit to vaccine recipients so has the incidence of Shingles, a reactivation of a latent VZV infection…

Varicella vaccination can reduce the incidence of the rare, but often fatal Group A streptococcal infectious complication of Necrotizing Fascitis: Varicella vaccination needed to avoid severe complications…

Hepatitis A infections prior to the introduction of the HAV vaccine were estimated to be about 270,000 annually (including anicteric and asymptomatic cases). Many of these cases were in children. With the introduction of the vaccine there has been a 95% reduction in cases in the US…

Hepatitis B – I suspect that the US universal neonatal/infant recommendation is based on the previous difficulties in adequately vaccinating only reportedly “high risk” individuals….

The rest are nearly the same schedule except for one less infant dose of DTaP, IPV, Hib and PCV. Denmark also recommends the HPV vaccine at age 12, although I have been administering it at age 9. I find parents are less “squeamish” about the sexual transmission aspect at that age. Remember, it not only prevents HPV triggered cervical cancer, but HPV associated throat and anal cancers as well, which is why I administered it to males and females equally.

Lastly, after nearly a 50-year career in pediatrics I have had the opportunity to see up close many of the infectious diseases we now have effective vaccines to prevent.

This was often not a pretty sight especially for the patients. Some of those infections had a high mortality and others a high morbidity.

But, in a way vaccines have become a victim of their own success. When you don’t see infectious diseases on a regular basis it is easy to become complacent about them. Out of sight. Out of mind. Or as the flipped quip goes, “Forgotten, but not gone”.

Keep up your great work.

XXXX MD

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In turn, I asked him for his “take on RSV, Covid and flu shots for kids.”

Here was his answer.

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Sure. Covid – I told parents we have the vaccine if they desire it. If not, no big deal. If they wanted more information I would discuss it, but no pressure for or against it.

The strident talk from the Biden Administration and the CDC on overhyping the COVID vaccine has done more to reduce trust in vaccinations than anything or anyone. The only COVID admissions I had were kids under 2 months of age with COVID croup.

Zero cases of MIS-C and zero cases of “Long COVID” whatever that is.

As for flu, no question in my experience it was a much more severe infection for kids than COVID. I’ve been waiting my whole career for someone to discover a way to make a flu vaccine that would actually work well, not be dependent on antibodies to surface proteins subject to rapid mutations, and immunity would last a lifetime…

RSV – Definitely on par with flu when it comes to severity particularly in infants under 6 months of age or premature infants. I thought Nirsevimab [passive immunization through RSV antibodies] was great and recommended it for my eligible patients. Unfortunately, Sanofi royally screwed up their initial estimate of patient demand for it and we ran out of product in 3 weeks.

N=1, I had a 6 year old patient with a genetic disorder causing severe failure to thrive and muscle weakness. The patient would have been a candidate for it, based on risk factors for pulmonary disease, but was disqualified based on the age criteria.

I wasn’t about to give a brand new drug (technically it’s not a vaccine) off label. The patient got RSV and ended up almost having a respiratory arrest in our office and ended up in the PICU [pediatric intensive care unit] for nearly a year! Imagine the benefit to the patient and family not to mention the cost savings if I were able to administer it and it actually worked…

As a 3rd year pediatric resident in 1978 I took care of a 4 week old with neonatal pertussis who was intubated for a month and survived despite his complication of fungal septicemia. Anytime you can prevent that complication I’m all for it. You remember cases like that for your entire career…

I’m an Evidence Based Medicine hardliner. If someone disagrees with me, fine. Just show me the data that proves your position or just admit you’re responding emotionally, not scientifically. Please don’t use my real name… I don’t need my wife getting any agita over it.