Feature Article: No Substitute: Alternative Vaccine Schedules Offer More Risk, Without Reward

Young children receive vaccines to protect them against at least 14 different infectious diseases. Since some of these vaccines require more than one dose, children can receive up to 26 injections by 2 years of age, with up to five shots being administered at one time.

This quantity and density of vaccines on the recommended schedule has caused some parents to request spacing out or withholding certain vaccines. While the consideration for a child’s safety is completely understandable, altering or delaying the child vaccine schedule recommended by the United States Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP), is not just the exercise of an abundance of caution. It is, in fact, risky. Here is why:

Febrile seizures

For example, the vaccination schedule set forth by the CDC’s Advisory Committee on Immunization Practices (ACIP) recommends the MMR and varicella vaccines should be administered between 12 and 15 months of age. A study recently published in Pediatrics, found that delaying vaccination of measles-containing vaccines — like the measles-mumps-rubella (MMR) or the measles-mumps-rubella-varicella (MMRV) — beyond 15 months of age increases the incidence of febrile, or fever-associated, seizures following vaccination.

Febrile seizures are convulsions in infants or small children brought on by a quickly rising or high-temperature fever. Although frightening for parents to see, febrile seizures are benign, typically brief, and extremely unlikely to cause any long-term effects. Fevers that result from vaccination tend to be “low-grade” fevers, so febrile seizures are not typical.

Increased susceptibility

While simply postponing or spacing out certain vaccines may seem harmless, there are no advantages to doing so. In fact, the delays not only increase the association of febrile seizures following some vaccines, but will also increase the amount of time children are susceptible to diseases for which vaccination has been delayed.

While susceptibility over a longer period of time may not seem very risky in a community in which the diseases are not being reported, the truth of the matter is that a parent may not have heard the disease is present; an outbreak could occur at any time; and immunity takes time to develop following vaccination.

Severity of symptoms

Further, the symptoms and outcomes of diseases are often much more severe than the risks associated with vaccines. For example, a rare but uniformly fatal consequence of measles can be subacute sclerosing panencephalitis (SSPE). SSPE is a rare disease of the central nervous system caused by a persistent, but unobservable measles infection. SSPE usually occurs in four stages characterized by behavior and personality changes; repetitive jerks, seizures and dementia; rigidity and unresponsiveness; and coma or vegetative state and death. Symptoms of SSPE can begin from one month to many years (4 to 10 years) after a measles infection. Findings from a few studies have indicated that the risk of developing SSPE is greater in children who suffer measles infections in the first five years of life, with the greatest risk occurring after infections during the child’s first year — providing another reason to reconsider delaying vaccination.

Read Emmalee Parker's story to learn about her and her parents’ experience with SSPE»

Additional doctor visits — added stress

Furthermore, from a practical standpoint, additional time between vaccines requires children to visit the doctor more often for more shots. This added barrier of logistics and planning can lead to missed appointments or increased medical costs or both. Studies have found children experience similar amounts of stress, as evidenced by the secretion of a hormone called cortisol, no matter the number of shots they are receiving. So in fact, additional visits to the doctor for more widely distributed vaccinations can actually increase the trauma of getting shots.

To some parents, redistributing or delaying vaccines may seem like a conservative approach to their child’s safety. But the reality is that added time comes with added risks and without added safety. The recommended vaccination schedule provides all the necessary protection we can give to children, with the least amount of measureable risk.

Additional resources

• Too Many Vaccines?: What You Should Know [PDF, 319KB]
• Recommended Immunization Schedule: What You Should Know [PDF, 338KB]