How many vaccines can safely be administered in one day?

Factual Questions
41

To add to what DSeid said, 1) there is no thimerosal preservative added to any routine childhood vaccine except flu vaccine in multidose containers (and even then there is a thimerosal-free alternative readily available).

Trace amounts of formaldehyde (used only in preparation of inactived virus vaccines) are considerably less than what your own body makes continually as part of normal metabolism. Amounts and significance are elegantly analyzed in this article, which looks at all the vaccines that might contain minute amounts of formaldehyde:
*
HepB - Recombivax - 3 doses (birth, 1-2 mos. and 6-18 mos.) - 7.5μg/dose
DTaP - Infanrix - 5 doses (2 mos., 4 mos., 6 mos., 15-18 mos. and 4-6 yrs.) - 100μg/dose
Hib - ActHIB - 3 doses (2 mos., 4 mos. and 12-15 mos.) - 0.5μg/dose
IPV - IPOL - 4 doses (2 mos., 4 mos., 6-18 mos. and 4-6 yrs.) - 100μg/dose
Influenza - Fluzone - 7 doses (6 mos., 12 mos. and yearly 2-6 yrs.) - 100μg/dose
HepA - Havrix - 2 doses (12 mos. and 6-18 mos. after first dose) - 100μg/dose

“That’s all of the vaccines on the recommended schedule for 0-6 years that contain formaldehyde. If a child got all of those doses all at once (which they never would), they would get a total of 1,824μg, or 1.824mg, of formaldehyde. A 3.2kg (~7lb) newborn with an average blood volume of 83.3mL/kg would naturally have, at any given time, about 575-862μg of formaldehyde circulating in their blood. By the time they are 6 years old (~46lb or 21kg), they’ll naturally have 3,562-5,342μg of formaldehyde in their blood. Bear in mind that the formaldehyde from each shot will not build up in their bodies from shot to shot, as it is very rapidly (within hours) metabolized and eliminated as formate in the urine or breathed out as CO2.”

“So what’s the most a child might get in a single office visit? That would probably be at their 6 month visit (when they are, on average, 16.5lbs or 7.5kg) with HepB, DTaP, IPV and flu, for a total of 307.5μg. That is about 160 times less than the total amount their body naturally produces every single day*. Compare that to the 428.4-1,516.4μg of formaldehyde in a single apple.”*

Parents’ eyes might glaze over with the full explanation, but they can understand the part about the apple.

“Doctor knows best” is not a good paradigm for modern medical practice, but neither is believing the results of a couple hours of Google-based searches are a legitimate counterpoint to the knowledge obtained via many years of medical school, residency training, clinical practice experience and continuing medical education. When ignorance proceeds to the point of arrogance, enabling and coddling ignorance is no longer tenable.

42

Presenting options that are harmful and of no benefit is not part of presenting information necessary to make informed decisions. I am under no obligation to offer my patients options that are harmful to them and others. An oncologist is under no obligation to tell patients that some people have tried apricot pits (Laetrile) for cancer and list that ineffective treatment as an option for patients to decide between. An oncologist who brings up the subject as something to discuss and decide about is at best an idiot and more likely a quack. Nor does an endocrinologist need to discuss every quack nutritional supplement that is out there purporting to cure diabetes. Same with a pediatrician and offering “alternative” vaccine schedules. One who does that is at best being an idiot.

Yes, the people who are the refusers often mistrust the medical profession as a whole. They prefer to trust celebrity endorsements. They can be reached, with a gentle sales approach and developing a relationship that gets to the point where they have good reason to trust me (or someone like me) more than the idiot on the internet or on Oprah. It is very very time consuming. Yes it feels good to have gotten through but it takes time away from so much else.

For years I have been an advocate for continuing to accept the refusers (and delayers) into our practice; I am now close to switching sides. Biggest reason honestly is because so many other practices are now refusing them and I do not want us to be the refuser dumping ground. It is not fair to us and it is not fair to our other patients. The down side of refusing to accept them as patients is that then the hardcores will end up clustered in fewer and fewer offices (increasing the risk of a real outbreak) and some of them in the hands of complete quacks. But accepting them in hope (again, not always without cause) that I can eventually succeed in making the sale is to some degree validating the decision as acceptable, no matter that I have them sign forms documenting that I have informed them of the risks, including death, to their own children and to others.

43

Sorry to belabor the point …

I am far from the paternalistic doctor knows best era but damn it, sometimes we do. NO. Whether or not I prescribe you antibiotics for your cold, write for whatever pill was advertised on TV to you, order the test that Uncle Harry told you to have, and so on … is NOT your “informed choice” to make. I won’t do it and will not enable your doing stupid things.

Yes, those who want someone who will can possibly find someone who will. And they are welcome to vote with their feet and go there. I will explain what choices are within the broad range of reasonable decisions and talk through the pros and cons of them. I will explain why I think the best course is what I think it is in this particular case. But my practice is not Burger King and “have it your way” is not our slogan.

44

Kudos, DSeid. We’re not here to please our patients, we’re here to offer them our educated and expert opinions on what their best options are.

45

Yes, most of the time you do. You went to school for years, had loads of practical training, keep up with your continuing education, and kick the pharma reps out of your office after you score the free samples for your less fortunate patients and review the actual clinical trials instead (or at least actually read the contraindications and potential side effects). (And that’s not tongue in cheek; I believe that.)

And then you compare spreading out vaccinations - only spreading out, not refusing them completely - you compare spreading them out to refusing treatment for cancer.

Is it the best choice for the younger sibling of school age children whose parents work outside the home? I doubt that.

Is it a fatal decision for most children, including single children with a stay at home parent, who probably aren’t expose to a lot of risk? I doubt that, too.

Doctors actively discouraged breast feeding, and not in some distant past. They encouraged pregnant women to smoke so they wouldn’t gain too much weight. They prescribed thalidomide*. Hell, they even promoted that idiotic food pyramid.

There are reasons that people do not blindly accept what their doctors tell them.
Making hyperbolic comparisons are unlikely to convince them.

And this comes from a person who, when a grandchild was born, informed the parents they would be disinherited if the child was not vaccinated.

  • Not in the US, I know. (I think.)
46

Okay. Point taken. I’ll compare it to delaying treatment for cancer and spreading out the cycles from what the clinical research has shown work most effectively. Better with that?

Should an oncologist discuss those options, nay are they are obligated to review those options as part of the informed decision-making process, and cooperate with patients who want to do it that way against their medical advice and established protocols, based on the fact that the patient distrusts the medical establishment and has read something on the internet or heard a celebrity discuss how they can use chemo more spread out if they eat an all fruit diet?

Should they if it is not “a fatal decision for most”, only for a smallish number?

47

You do realize that the mantra “Science wuz wrong before!” does not automatically give credence to current non-evidence-based beliefs?

I realize the popularity of the fallacy, but really: pointing to past erroneous medical beliefs (the Semmelweis hand-washing tale and alleged slowness to embrace the role of H. pylori in gastric ulcers are also very big with alties) to show why we shouldn’t dismiss therapeutic urine-drinking (or any other dopey health practice) is dumb.