WWYD: pediatrician changing stance on vaccine schedule

[megs4413]

I'd love to keep this as light on drama as possible...

I've posted before about our weird vaccine issues. My son reacted to the DTaP (twice, once each dose he got) and the MMR (only got one dose and got the mumps since it's live virus) and never got the varicella because he caught chicken pox wild before he could get the vax. ALL OF THIS is well-documented in his medical records.

Up to now, his pediatrician has left it there. He is TOTALLY up to date with all vaccines except for what I mentioned above (varicella, pertussis, mmr) and has medical exemptions for the ones he is not up to date for. But today, he went in for his well check and she wanted to give him the MMR and varicella. I was like......what? she said, "legally he has to have documentation on these" and I was like, "why?" she said for school and I was like, "um he's homeschooled. So, no."

But she said "they won't look at his history, they will just count and see that he hasn't had them all." I was like "OK, well aren't most people immune after one dose of MMR? Can't we check that?" and she said, "you want to do titers? OK, we can do that. We might as well add on the varicella and pertussis." So that's where we landed, but now I'm stewing on this and I am thinking, "WHO THE F IS THEY!?!?" is she meaning her insurance company? her practice manager? WHO? And in any case, he has DOCUMENTED medical exemptions to these particular vaxes. He gets ALL other required vaxes (we skip the flu vax.) Why is this suddenly a problem?

Should I change pediatricians? Am i going to start finding this everywhere? Would you fight this or just let him have these vaxes again if he doesn't show immune in titers? I am so confused now. I'm just blindsided and feeling a little betrayed by our pediatrician who I have always loved so much. Anyone have any insight or advice? I need to be talked down, I'm afraid.

[Snow mom]

I would have asked her who " they" is. I imagine since she was talking about school they refers to whoever checks vax for school aged children. My understanding is HSers are required to have the same vaxes as public school students but certainly this might change state to state. I'd wait to see what the titers show and try not to stew too much before you get those results. Once you have results in hand you can discuss with your pediatrician how you'd like to move forward and get her POV. If that clashes with your decision then you can consider looking for a new pediatrician, but I do think finding pediatrician a who are okay with skipping vaxes (especially if his titers show he isn't immune) is going to continue getting harder.

[mackmama]

I am so sorry that you're experiencing an about-face from your trusted doctor. How confusing, and I would feel betrayed too. I would call your pediatrician's office, ask for your pedi to call you back, and explain how you are feeling. You need a medical doctor you can trust and who is on your team. You need to ask if this new stance is a sign of changing protocols within their office (only accepting patients who do full vaccines) or if there is something else at play. Just be honest and direct. Depending on what state you're in, I could imagine it might be a sign of recent laws that have been passed re schools and vaccines. Once you have this info, then you can investigate your options in terms of whether you are going to stay with this doctor or call some other practices.

[OKKiddo]

Megs, your inbox is full.

[SnuggleBuggles]

Our pediatrician asked me to have ds2 up to date by age 2yo, as we had been slowly staggering everything. It wasn't for kickbacks but it was because the state did incentivize having kids vaccinated by that age. I was aiming for 2 anyway so I was happy to go along with it.

[Reader]

I'd love to keep this as light on drama as possible...

I've posted before about our weird vaccine issues. My son reacted to the DTaP (twice, once each dose he got) and the MMR (only got one dose and got the mumps since it's live virus) and never got the varicella because he caught chicken pox wild before he could get the vax. ALL OF THIS is well-documented in his medical records.

Up to now, his pediatrician has left it there. He is TOTALLY up to date with all vaccines except for what I mentioned above (varicella, pertussis, mmr) and has medical exemptions for the ones he is not up to date for. But today, he went in for his well check and she wanted to give him the MMR and varicella. I was like......what? she said, "legally he has to have documentation on these" and I was like, "why?" she said for school and I was like, "um he's homeschooled. So, no."

But she said "they won't look at his history, they will just count and see that he hasn't had them all." I was like "OK, well aren't most people immune after one dose of MMR? Can't we check that?" and she said, "you want to do titers? OK, we can do that. We might as well add on the varicella and pertussis." So that's where we landed, but now I'm stewing on this and I am thinking, "WHO THE F IS THEY!?!?" is she meaning her insurance company? her practice manager? WHO? And in any case, he has DOCUMENTED medical exemptions to these particular vaxes. He gets ALL other required vaxes (we skip the flu vax.) Why is this suddenly a problem?

Should I change pediatricians? Am i going to start finding this everywhere? Would you fight this or just let him have these vaxes again if he doesn't show immune in titers? I am so confused now. I'm just blindsided and feeling a little betrayed by our pediatrician who I have always loved so much. Anyone have any insight or advice? I need to be talked down, I'm afraid.

Whether you must have documentation depends on what state you are in. For example, in California, you must have immunization documentation for your child entering kindergarten and 7th grade because a homeschooler functions as a private school. I think most states don't require documentation for homeschoolers but I'm not up on other states.

[niccig]

I would try to not worry until you get the titers back. Chicken pox he is probably fine as had the disease and one shot of the MMR is enough for large % of people that get it, so numbers are on your side here. DTap, I'm not sure how many shots you need for that. Wait until you know if this will be an issue or not. If his titers come back and he doesn't have immunity, if your state has medical exception for school, and you have the documented medical exception, you can argue that. Definitley find out who the "they are" that requires the shot. If it's for other reason and not legally for school (practice policy, insurance, health department push) well, then they can say whatever they want, but you don't have to give permission.

On the flip side, also look at this as a chance to get some paperwork that shows your DS's immunity. Keep those results with your vax records, so when it's questioned again, you'll have proof of his titers. I started an internship at a hospital and had to go get a 2nd MMR shot. I could've had titers drawn as I've had one shot and according to my mother, I acutally had measles as a kid, but I didn't have the time to get the titers done. It was easier, quicker, cheaper for me to get a 2nd shot. And I wonder if that's the push behind giving him the shots over checkign titers, it's easier, cheaper and quicker. But now that you'll have the titers drawn, you'll have that as proof. Don't lose it!!!

[megs4413]

Megs, your inbox is full.

fixed it!

[marymoo86]

I'm confused as to why you would need titers checked if he has documented medical exemptions and he has had the disease?

I would switch to a family doctor without another visit. Your pedi wanting to vaccinate with that history and those reasons means she does not have your child's medical history and health as her main concern.

[megs4413]

I'm confused as to why you would need titers checked if he has documented medical exemptions and he has had the disease?

I would switch to a family doctor without another visit. Your pedi wanting to vaccinate with that history and those reasons means she does not have your child's medical history and health as her main concern.

This is what's rubbing me so wrong. I just feel very betrayed and confused. The whole thing is we should be able to trust the advice of our pediatricians. I'm not a doctor, so I need one to help me navigate this. But, how am I supposed to trust her when her opinion is changing for no apparent reason at all?

[lalasmama]

Former vaccine coordinator for a family practice office here :) I'm guessing "they" is the OP's statewide vaccine system. Feds require x% of kids are immunized statewide to qualify/keep federally-supplied free vaccines. Depending on the state's handling of those vaccines, the OP's clinic may be at risk of losing their federally-supplied vaccines if they aren't vaccinating a high enough percentage of patients.

Every few months, we used to get a survey for 5-10 kids around the age of 2yo, and had to indicate their vaccine status via vaccine record. There's no "medically withheld" option, so if we get a survey on a kid or two allergic to the DTap vaccine, it can make them look very behind. Nothing is done with these surveys where specific follow-up is done for these "under-vaccinated" (because of allergy) kids. It's really just a data-gathering exercise.

[chlobo]

Former vaccine coordinator for a family practice office here :) I'm guessing "they" is the OP's statewide vaccine system. Feds require x% of kids are immunized statewide to qualify/keep federally-supplied free vaccines. Depending on the state's handling of those vaccines, the OP's clinic may be at risk of losing their federally-supplied vaccines if they aren't vaccinating a high enough percentage of patients.

Every few months, we used to get a survey for 5-10 kids around the age of 2yo, and had to indicate their vaccine status via vaccine record. There's no "medically withheld" option, so if we get a survey on a kid or two allergic to the DTap vaccine, it can make them look very behind. Nothing is done with these surveys where specific follow-up is done for these "under-vaccinated" (because of allergy) kids. It's really just a data-gathering exercise.

It seems like there is something wrong with this system if it doesn't allow for documented medical allergies that are life threatening to the child. And seems like the doctor should have been able to sort that out without alarming the patient.

[calebsmama03]

Hugs. I'm sorry you're having to deal with this. I'm worried for our upcoming check ups in a few weeks- with all the measles/vaccine hysteria I'm concerned that our ped will do the same, esp for dd and ds2, since they are delayed due to ds1 reactions. Personally I would have a hard time trusting this doc again, so I'd be inclined to look around and interview new docs. However, I know that is stressful, too. Hopefully his titters will be fine.

[StantonHyde]

I would call the clinic and ask why the change--especially given your child's history. I am a big pro-vaxer, but what you describe is just odd. I get that there is often a "they" but it's your doctor's job to be the buffer between you and "them". I would call to see what is up and if it is a big, new shift that is going to keep going, then I might very well find a doctor willing to work with me.

[doberbrat]

I would call to see what is up and if it is a big, new shift that is going to keep going, then I might very well find a doctor willing to work with me.

See, I dont think this is a dr who isn't "willing to work with you" its more of a dr who has a patient who has DOCUMENTED issues with vaccines and yet wants to administer them anyways. And thats a scary thing IMO.


I'm confused as to why you would need titers checked if he has documented medical exemptions and he has had the disease?

I would switch to a family doctor without another visit. Your pedi wanting to vaccinate with that history and those reasons means she does not have your child's medical history and health as her main concern.
I agree. I interpret this as the dr saying that people will be too lazy to look past the 'missing' vax to see WHY it hasnt been administered.

Will your ins pay for titers? I havent had them done for my human kids but I've had them done for a few dogs and they weren't cheap. Considering his history, will you vaccinate if immunity isnt apparent? I'd Only run titers if I were concerned and were going to update as a result.

[StantonHyde]

I had to have MMR titers drawn when I applied for my job. I don't remember it being expensive and I had cheap insurance at the time.

[twowhat?]

I don't get it. When you say "We vaccinate on time with all the recommended vaccines, except for XYZ because my son has documented reactions to these vaccines (in his charts!!), for which we request a medical exemption"...what does the doctor say? Or is she not even listening long enough for you to explain that he has had documented reactions to those vaccines?

I would just stay firm! State the facts. Bring copies of his charts (request them if you don't have them) and simply say "he cannot get those vaccines because of THIS and wave the papers in front of their faces). Sheeesh, sorry you're having such a hard time with this!!!

I think the titers is probably a fine compromise since he's had one dose of MMR, but if the titers don't give him his "pass", just stay firm.

[trales]

If I were in your situation, I would:
a - talk to my doctor and ask all the questions asked above.
b - get the titers done just so I had them
c - have the paper with medical reasons at the ready at all times.

Then I would make a decision to switch pedi's or not. Your situation is really stressful and hard. Good luck.

[o_mom]

I had to have MMR titers drawn when I applied for my job. I don't remember it being expensive and I had cheap insurance at the time.

Yes - they were not too expensive for the MMR titers here and I had the V titer as well. Rubella and Varicella are routinely done on pregnant women.

I would do them anyway, though the CP titer is not really needed if you have documented disease, but who knows in the future as it is always changing. When my oldest started school, it was enough that I said he had CP. Now they want a doctor's statement that he had it. So a titer gives you a documented immunity so you don't have to go into all the "this is what happened and why we don't do it" and hope that the doctor/school/employer in the future doesn't think they know better and that it wasn't really enough for a medical exemption. The other thing is that if he is exposed to any of those in the future, he would fall in the "documented immunity" group, which may help your anxiety if nothing else. If he is not immune, then you know that and would hopefully recognize and be treated sooner because it was not assumed he was immune (such as my niece with "CP-like rash" that can't be CP because she was vaccinated:rolleye0014:).

[HannaAddict]

I would want to know myself if my child was protected so would be happy they checked. With the problems of too many opting out just because, sadly it will make true medical exceptions more scrutinized. I wouldn't switch peds over this but think of rational questions and discuss with them. And don't see why checking for immunity is a problem, it seems like good info to have.

[Simon]

I agree that sounded strange and I would be upset in your shoes, too. It sounded like she was saying the reaction wasn't "good enough" for an explanation. If you otherwise like her, I'd give her another appointment/chance and see how I felt. In the meantime, the titers can be used to put your mind at ease.

[rin]

It seems like there is something wrong with this system if it doesn't allow for documented medical allergies that are life threatening to the child. And seems like the doctor should have been able to sort that out without alarming the patient.

My guess is that with the rise of personal exemptions from vaccinations, medical care providers may be more likely to make the assumption that deviations from the recommended schedule are based on personal preference. It's unfortunate, and I'm very sorry you're dealing with this.

As far as state-wide reporting goes, from a public health perspective, it doesn't matter *why* someone hasn't received a vaccination: that person is still vulnerable to that disease. If vaccination levels in a community fall below a certain percentage (regardless of why those people haven't received a vaccination), that entire community is unprotected in case of an outbreak. I'm guessing that the state-wide surveys are collecting data for those reasons; in communities where the vaccination levels fall below the herd immunity threshold people who *can't* receive vaccines (i.e. people like the OP's son, tiny infants/toddlers, immune-compromised people, etc) are at increased risk, so the state needs to try to find out where there might be pockets of people who are endangered. At the end of the day, if measles sweeps through a community, it doesn't matter *why* any given person didn't get the vaccine, that person is now at risk.

OP, I would also be confused and disturbed, but I'd try to get back in touch with your doctor to clarify. If she's actually suggesting that your son, with a documented medical exemption, receive a vaccine that he's previously reacted to, that's horrifying. I'm hoping there's some sort of misunderstanding on her part; maybe a follow-up call or email with the office could help? That said, I wouldn't mind getting titers drawn; it would give me peace of mind to know what my child's status was in the case that an outbreak did come through the community.

[calebsmama03]

I would want to know myself if my child was protected so would be happy they checked. With the problems of too many opting out just because, sadly it will make true medical exceptions more scrutinized. I wouldn't switch peds over this but think of rational questions and discuss with them. And don't see why checking for immunity is a problem, it seems like good info to have.

I don't think it's the running titters that is a problem, but the ped just suggesting out of hand that he get the shots "just because" that would concern me. It shows that the ped isn't looking at the particular child's situation as unique.

Another point, for people who haven't experienced this personally, is that (at least in my state) having a documented *reaction* to a vax (even moderate to severe) is not the same as having a medical exemption and does not guarantee one. Perhaps it is because there is a philosophical exemption clause here and peds don't want to put their official blessing on it, but I was told the grounds for an official medical exemption due to a previous reaction are very limited. Essentially if the child didn't have anaphylaxis or immediate prolonged seizures they don't consider it severe enough to officially pre empt future vaxes. Even after a third moderate reaction at a much older age, we were told ds probably shouldn't get the pertussis part again but the doc wouldn't sign the medical exemption and said to just keep signing the personal exemption form. There are many stories of kids who had seizures and other more severe reactions being told to not stop getting that vax. And it only applies to the one vax, not to any others even tho they can't answer which part of the vax caused the reaction so that ingredient can be avoided entirely. It is frustrating. OP didn't specify whether her son has a medical exemption and it is quite possible he does, which makes this even more puzzling, but I wanted to point out the distinction because it really is significant in terms of a doc acknowledging the potential for future harm.

[Kindra178]

I don't think it's the running titters that is a problem, but the ped just suggesting out of hand that he get the shots "just because" that would concern me. It shows that the ped isn't looking at the particular child's situation as unique.

Another point, for people who haven't experienced this personally, is that (at least in my state) having a documented *reaction* to a vax (even moderate to severe) is not the same as having a medical exemption and does not guarantee one. Perhaps it is because there is a philosophical exemption clause here and peds don't want to put their official blessing on it, but I was told the grounds for an official medical exemption due to a previous reaction are very limited. Essentially if the child didn't have anaphylaxis or immediate prolonged seizures they don't consider it severe enough to officially pre empt future vaxes. Even after a third moderate reaction at a much older age, we were told ds probably shouldn't get the pertussis part again but the doc wouldn't sign the medical exemption and said to just keep signing the personal exemption form. There are many stories of kids who had seizures and other more severe reactions being told to not stop getting that vax. And it only applies to the one vax, not to any others even tho they can't answer which part of the vax caused the reaction so that ingredient can be avoided entirely. It is frustrating. OP didn't specify whether her son has a medical exemption and it is quite possible he does, which makes this even more puzzling, but I wanted to point out the distinction because it really is significant in terms of a doc acknowledging the potential for future harm.

But isn't that the point of an exemption for medical reasons? Put another way, what does severe reaction mean? Maybe the exemption language of the law should clarify and specify what type of previous reactions would constitute waiver. Remember, the purpose of getting rid of exemptions is to insure vaccine communicable diseases are eradicated, and not based on the whim of the parents. In our case, 2/3 of my kids had sky high fevers and were listless following their 4 month shot. Ds1 got a had a terrible reaction to DTap at age 4 - his arm was swollen from shoulder to wrist. Ds3 had a VAERS reported viral xantham following his Dtap or MMR at age 4. Based on my kids experience with minor reactions, should I be allowed to get an exemption?

[o_mom]

But isn't that the point of an exemption for medical reasons? Put another way, what does severe reaction mean? Maybe the exemption language of the law should clarify and specify what type of previous reactions would constitute waiver. Remember, the purpose of getting rid of exemptions is to insure vaccine communicable diseases are eradicated, and not based on the whim of the parents. In our case, 2/3 of my kids had sky high fevers and were listless following their 4 month shot. Ds1 got a had a terrible reaction to DTap at age 4 - his arm was swollen from shoulder to wrist. Ds3 had a VAERS reported viral xantham following his Dtap or MMR at age 4. Based on my kids experience with minor reactions, should I be allowed to get an exemption?

The CDC already has a list of what qualifies for a medical exemption... It is pretty limited. So seizures following a vaccine are OK as long as there is no coma, loss of consciousness and they are not "prolonged" (probably anything over 5 min):

http://www.cdc.gov/vaccines/recs/vac-admin/contraindications-vacc.htm

It is unlikely that a doctor would sign an exemption unless it is specifically listed on the sheet. That's why I think OP is better off getting titers which may eliminate the need for a medical exemption in the future.

[Kindra178]

The CDC already has a list of what qualifies for a medical exemption... It is pretty limited. So seizures following a vaccine are OK as long as there is no coma, loss of consciousness and they are not "prolonged" (probably anything over 5 min):

http://www.cdc.gov/vaccines/recs/vac-admin/contraindications-vacc.htm

It is unlikely that a doctor would sign an exemption unless it is specifically listed on the sheet. That's why I think OP is better off getting titers which may eliminate the need for a medical exemption in the future.


The CDC parameters are just recommendations. They are not federal law. States make and enforce the laws on vaccine mandates. People choose religious or personal exemptions because medical exemptions are often and rightfully too hard to obtain and need to be signed off by an MD/DO. I agree with you that titers would be the way to proceed here.

[o_mom]

The CDC parameters are just recommendations. They are not federal law. States make and enforce the laws on vaccine mandates. People choose religious or personal exemptions because medical exemptions are often and rightfully too hard to obtain and need to be signed off by an MD/DO. I agree with you that titers would be the way to proceed here.

Right, but I would guess any law will follow the CDC recommendations and a doctor is going to go with those because it is the path of least liability.