I’m a pediatrician. Here’s how I decide when to vaccinate my children. | Expert Opinion
The real math here is about what risk you can live with as a parent.
The last line of my son’s first letter home from sleepaway camp was: “Also, there was a bat in our cabin at 2 a.m. and we had to kill it.”
As both a parent and a pediatrician, I panicked. After reviewing the Centers for Disease Control and Prevention guidance on treatment after rabies exposure, I determined that his chance of developing rabies was extremely low (1 to 2 out of 331 million people), but the risks associated with rabies disease — including death — were too high. He needed to get vaccinated.
This weighing of pros and cons of the disease vs. the vaccine is how I help many of my patients’ parents determine whether they want to vaccinate their child. Recently, a family asked me why it was important to vaccinate for varicella, or chicken pox, because it seemed like a harmless condition that many of us experienced growing up.
I could have told them that in the first 25 years of the chicken pox vaccine, it prevented an estimated 91 million cases of itchy children, 238,000 hospitalizations, and 2,000 deaths, and that is all true. Instead, my answer was more personal.
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While most adults recall a mild case of chicken pox — a few days of itchiness — the illness can be severe. It was for me. In the mid-1980s, before the chicken pox vaccine was available, I was hospitalized with a serious case of chicken pox. I was so young that I remember little of the experience other than one of my eyes being swollen shut, leaving me with limited vision for coloring in my activity books.
For my parents, my hospitalization meant a week of missed wages, childcare expenses for my brother, and hospital bills. Most of all, though, it was a week of worry. The same kind of worry that I faced when deciding whether to vaccinate my son against rabies.
Each side of this decision has risk — the risk of the disease or the risk of the vaccine. I could have shared with this family that serious adverse events were reported in only 0.8 per 1 million doses of the chicken pox vaccine, making the risk of serious adverse events from this vaccine extremely rare.
But for parents, this decision is not about weighing the numbers: 0.8/1 million risk from vaccine vs. 1-2/100,000 fatality rate from disease. The real math here is about what risk you can live with as a parent.
Some parents worry that if their child was one who experienced a rare complication of a vaccine, they would have a hard time forgiving themselves. As a parent, I worry about my child having a complication of a disease that I could have prevented. And as a pediatrician working in one of the busiest children’s hospitals in the country, I have seen children who have suffered the complications of these diseases. These events happen — and they change lives.
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So, my son spent the remainder of August, which happened to be National Immunization Awareness Month, getting four doses of the rabies vaccine. The risk of the vaccine is extremely low, and the benefit is a tremendous peace of mind. When vaccines work well, nothing happens, so we will never know if he would have developed rabies, but that’s one unanswerable question with which we are both happy to live.