If I were to be invited to participate in a consultation about public health or global vaccine policy, I would readily state that vaccines do much more good than harm.

In my office I am consulted about one child at a time. I tell the parents that I believe that each vaccine deserves a risk/benefit analysis with each individual child. Families which travel extensively are certainly more likely to be exposed to diseases nearly extinct in America. Breastfeeding babies in healthy families whose vacations are less than exotic are less likely to be anywhere near someone with polio, diphtheria or measles.

I have listened to many different points of view about vaccination and am very tired of hearing people "shout" about the issue. Calm, reasoned discussions will give parents the information they need to make informed choices about vaccines.

One simple fact: 99% of doctors favor vaccinating every child and teenager with available vaccines at all the appropriate ages. Only a very small number of doctors and other authorities favor any other point of view, be it delaying vaccines or not giving some or all of the shots.

The first shot offered to your baby is a hepatitis B vaccination which some doctors still choose to give in the hospital within the first 48 hours of life. Hepatitis B is a potentially "permanent" illness which can lead to chronic liver inflammation, damage and eventually liver cancer. The vaccine has helped reduce the incidence of hepatitis B in America by 90%. The disease is contracted through high risk behavior: intravenous drug use or sexual contact but some authorities say that more mundane activities such as sharing a toothbrush or razor can transmit the virus. I prefer to give this vaccine much later in life when I give it. A small minority of vaccine experts argue that the hepatitis has adverse consequences which lead to autoimmune diseases like multiple sclerosis and diabetes. Although they have gathered data supporting their position, the vast majority of experts refute this idea and support universal vaccination against hepatitis B.

At the six week or two month appointment, the DPaT, IPV, HIB, Prevnar and second HBV are routinely given. These initials stand for, respectively, diphtheria/acellular pertussis/tetanus, inactivated polio vaccine, hemophilus influenza B, and the newer pneumococcus vaccine. In large measure because of vaccination policies, none of these illnesses are common in America. We see an average of one case per year of diphtheria per year in the entire country and 60 to 70 cases of tetanus. There are still thousands of cases of pertussis (whooping cough), most of which do not get diagnosed and which cause rare hospitalizations and even rarer fatalities. Whooping cough can be fatal in children under six weeks of age (1 out of 200 cases in the midst of an epidemic) and in virtually no other cases.

Tetanus is very rare and occurs mostly in older adults and others with compromised immune systems. The problem I have faced with children who do not have complete tetanus immunity is that I cannot answer the question, "Could this wound cause tetanus? What are the chances?" The honest answer is that a healthy immune system can almost always defeat the clostridia tetani bacterium. Almost always. I have no percentage nor great answer for people who have fewer than three shots or whose immunity is "out of date." I am quite certain that very few children would contract tetanus even if they were unvaccinated, but I have no proof. I worry, parents worry and the only answer is to get a "tetanus immune globulin" injection to create instant immunity. After a bad wound, there is no certainty of protection with just one shot or even with a second tetanus (or DPaT) injection.

Wild polio has not been in America since 1979. There is presently no wild polio in the Western Hemisphere and it has been obliterated from the Pacific Rim. Most cases of polio are in smaller villages in Africa and in countries in Asia. There have not been recorded cases of immigrants to the USA bringing in polio for decades. Over the past two decades, there have been sporadic outbreaks in Jamaica, the Netherlands, Israel and elsewhere when a person emigrated from another country and found a susceptible group of unvaccinated people. The Netherlands outbreak was among a group of Amish. Many docs and grandparents, and some parents remember the polio epidemic of the 1950s. There is a lot of scientific support and a huge amount of emotional support for continuing to vaccinate thoroughly against this illness even though it no longer exists in America. The elimination of the oral polio immunization, which was a "live" vaccine, has also eliminated vaccine-associated polio in the U.S. Other countries still use this vaccine and it works extremely well. The risk was small, but the IPV doesn't carry even that tiny chance of transmitting polio from a vaccinee to a susceptible adult or child.

Hemophilus influenza B used to be the major cause of meningitis under two years of age and now that type of meningitis has been almost completely eliminated from pediatric practice. This is a true testimony to the effectiveness of this shot. It is also a strong argument for initiating the risk/benefit analysis I mentioned. Again, a very small minority of vaccine researchers have concluded that the HIB vaccine is another cause of autoimmune problems. There have even been research articles in mainstream medical journals supporting this point of view. And, again, the vast majority (99% or more) of physicians and experts do not believe that the risk outweighs the benefits. Besides meningitis, this bacteria can cause epiglottitis and other "invasive" infections. I have not seen a case of HIB disease in quite a few years.

The Prevnar vaccine is too new for me to recommend. The number of cases of Pneumococcal ear infections which could be prevented is very small and the number of cases of meningitis prevented is also small. I have no quarrel with doctors who recommend the shot or with parents who choose to get it. I have very strong objections to advertising this immunization to the general public on television. I don't think enough information can be disseminated in 60 seconds.

The second HBV continues the buildup of antibodies against hepatitis B.

(The other commonly mentioned hepatitides are hep A and hep C. Hepatitis A is not a permanent disease but can ruin an adult's vacation and even lead to hospitalization. The vaccine must be considered seriously by travelers. Hepatitis C is deadly and we have no vaccine for this or the other most-commonly discussed sexually transmitted killer, HIV.)

DPaT, HIB and IPV booster doses are given at the 4 month check up and then another DPaT and HIB at the six month visit. Most experts do not give a third IPV until the 18 month visit. The DPaT is given again at 18 months as is the HIB. A third HBV is given at 18 months of age although this timing may vary.

At one year of age, a child is to receive the measles/mumps/rubella vaccine. The MMR has received more notoriety in the past year or two than all the other shots combined. Research in England and elsewhere tied the shot to an increase in intestinal problems linked with autism. As I have mentioned over and over again above, the vast majority of experts discount these findings and feel that the benefits of the triple shot outweigh the risk. They remind us that, even though America is in the third year during which we will have fewer than 100 cases of measles reported, in India, there are an average of 1,000,000 deaths each year. Most of these deaths are in children. Rubella is dangerous to a fetus at certain stages of pregnancy and mumps can decrease fertility in men who catch the disease. I evaluate this vaccine and discuss it on a case by case basis in my office.

Vaccinating college students against meningococcal meningitis has become official policy on many campuses. If we vaccinate every single college student against this terrible disease, it has been estimated that we would prevent a half dozen cases of the disease each year. If the vaccine has any risk associated (none has been proved) this benefit is not great enough in my opinion.

In a public venue such as this, or on a TV show or in a national newsmagazine, I don't think enough of a dialogue or evaluation can take place. For that reason, I would rather attempt to give information and let parents expand their knowledge with reading and talking. I do not vaccinate all of my patients and I don't feel that these partially vaccinated or unvaccinated children are at high risk. I think that if national vaccine policy shifts away from universal vaccination, outbreaks could occur.