Under-Vaccination and Health Care Utilization / ER Visits and Hospitalizations

ER SignUnder-vaccination may have health benefits.  

This recent study looked at almost 1/3 of a million children (323,247), assessing rates of vaccination and comparing the health of those fully vaccinated to those that are under-vaccinated.  Of 323,247 children born between 2004 and 2008, 48.7% were under-vaccinated for at least 1 day before age 24 months. Children who were under-vaccinated because of parental choice had lower rates of outpatient visits and emergency department encounters than age-appropriately vaccinated children. My experience has been very similar, with huge health care savings and reduced illness for those families that are vaccinating slower than the current AAP/ CDC / ACIP schedule.  We need more studies of this kind, as the decision to vaccinate selectively is often looked down on.  This has been evidenced by the fact that so many pediatricians are now choosing to discharge from their practice any patients that decline vaccines. 

The difficult task ahead will be how to balance the benefits of improved health (I know there will be less immune related illness, like eczema and asthma, and my experience has seen reduced ADD, ADHD, and autism) with the slightly increased risk of a vaccine preventable disease.  As a hypothetical question, what if a selective vaccine schedule reduced your chance of autism from 1 in 50 to 1 in 1000 and cut the risk of asthma, eczema, ADHD, anxiety, and other autoimmune diseases by 50%, but resulted in one in 10,000 dying of pertussis, or getting meningitis?  In my practice, I strongly encourage the vaccines that prevent pertussis and the Hib and Prevnar to prevent meningitis, so I doubt this hypothetical would even come up, but these are the real tough questions that need to be addressed.  Real informed consent in the future should include information about both the risks and the benefits of all the options:

1. Do all the vaccines as recommended by the CDC/ AAP / ACIP

2. Do a selective schedule

3. Avoid all vaccines

 

http://archpedi.jamanetwork.com/article.aspx?articleid=1558057#qundefined

Dr. Paul

 

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