Like with her three other children, Tracy Daly of the Town of Beekman had her fourth child, Robbie, vaccinated according to the recommended schedule.
But her son, who is 5 and has Down syndrome, soon fell behind on his immunizations because of delays from the multiple surgeries he underwent for cataracts, tonsillitis, adenoid removal and other conditions.
“One year, he ended up with nine surgeries,” says Daly, who is executive director of the Down Syndrome Association of the Hudson Valley, a volunteer organization established by a group of parents in the 1980s that aims to increase community awareness of Down syndrome. “It was hard to stay on schedule. You don’t want to vaccinate two weeks before or after surgery.”
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Then she says her son’s behavior changed after he received a Measles, Mumps and Rubella (MMR) vaccination.
“He was ornery, sluggish, not ‘with it’ for a good three months,” she adds.
Because of Robbie’s reaction, Daly decided against further immunizations for him. When he entered kindergarten last month, it was under the school’s stipulation that he not attend class if there’s an outbreak of anything he’s not immunized against.
Daly said the Down Syndrome Association of the Hudson Valley basically follows the vaccination guidelines of National Down Syndrome Society, which, like the American Academy of Pediatrics (AAP), recommends that children with special needs follow the same vaccine schedule as other children do.
Daly isn’t convinced.
“I would immunize him, but given Robbie’s genetic makeup…nobody could tell me for sure that it isn’t going to harm him and I’m not willing to take that chance,” she says.
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Dr. Meg Fisher, a pediatric infectious disease specialist with the American Academy of Pediatrics (AAP) says it’s particularly important that kids with special needs are protected against all vaccine-preventable diseases.
“All of these infections that are dangerous to children with usual needs are, indeed, dangerous to children with special needs,” adds Dr. Fisher, who also is a member of the AAP’s organization’s infections and outbreaks committee.
In fact, she says, during the influenza pandemic of 2009, children with special needs were over-represented in both intensive care units and in developing severe complications from the flu, whether or not they had an existing respiratory condition.
According to a U.S. Centers for Disease Control and Prevention, only half of children with neurologic or neurodevelopmental conditions receive the flu shot each year. Although that number is close to the flu vaccination rate for all kids, it can cause a conundrum for families because kids with special needs face bigger risks of hospitalization or even death if they contract the flu.
Other conditions may also warrant special consideration. For example, the America Heart Association suggests that children with congenital heart defects may actually need less medication to get through an illness instead of more and they caution against giving antibiotics to prevent infections (with a few notable exceptions) as antibiotic resistance may develop.
Some parents, whether their children have special needs or not, remain hesitant to having their child immunized, Dr. Fisher says, perhaps because they heard, read or were told things that made them concerned about not wanting to ‘do anything extra’ to their children.
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“In fact, it’s very important that they immunize their children to protect them,” she says, especially since children with special needs are often directly involved with kids of all abilities at school, in camps and in other settings, which may leave them vulnerable to diseases they’re not fully protected against.
In New York State, school immunization requirements for all children in childcare, nursery school, pre-kindergarten programs and grades K through 12 are established as part of the state public health law. There are no separate laws or regulations for immunizations of children with developmental disabilities, although documented medical and religious exemptions are allowed.
In all, the Centers for Disease Control, which recommends that all children be vaccinated according to the recommended schedule, has found that the country’s vaccination exemption rates are low. In its 2014-2015 they found that state vaccination exemption levels ranged from less than 0.1 percent to 6.5 percent, with the overall national vaccination exemption at a median level of 1.7 percent.
“For most special needs children, there’s no vaccine that they would need to worry about,” says Dr. Fisher – although there are instances when vaccinating might be contra-indicated, such as if a child with special needs was on a medicine that altered his immune system.
“The trends really haven’t changed a lot,” said Fisher. “Pediatricians have always recommended immunizing children with or without special needs. We know that children with special needs may get sicker with these diseases so we particularly want to ensure that they’re immunized.”
While there’s no evidence that children with special needs have more reactions to vaccines than other kids do, Dr, Fisher says that because the fever caused by some immunizations can trigger a seizure in kids with special needs that have a seizure disorder, some doctors administer an anti-fever medication when immunizing those children.
While some people worry about the metals used in vaccines, Dr. Fisher says the quantities of aluminum (small amounts of which have been added to vaccines since the 1930s to help the body build stronger immunity against the germ in the vaccine), for example, aren’t enough to be troubling,
“Aluminum is a natural product which is not harmful in the amounts used in vaccines,” she says. “This may be a concern but there is no scientific basis for such a concern.”
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To ease the anxiety that many kids with special needs feel during doctor visits — which may be due to a heightened sensitivity to noise, having to wait, anticipation etc. — some medical institutions are making accommodations for kids with special needs, especially when a visit includes an immunization.
Walter Shuster, president of the Down Syndrome Association Hudson Valley has twin girls who are 3, one of whom has Down Syndrome.
“I’m all for immunizations,” says Shuster, who lives in Wappingers Falls. “I’ve immunized both girls.”
Shuster says he doesn’t believe the hype about immunizations, including that they cause autism.
Neither of his girls has had a bad reaction to any of their immunizations, which they’ve gotten on the same schedule that other children have. Both of his daughters recently started public preschool at the Mid-Hudson Regional Learning Center in Poughkeepsie.
“The chances of something happening because of a measles vaccination — to me, it doesn’t make sense,” Shuster adds. “It might be this one in 30,000 [chance], rather than, the next thing you know, my child is infecting a whole school of children with a disease. That’s a lot more dangerous.”
Karen Maserjian Shan is a freelance writer who lives in Poughkeepsie.