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Vaccine Experts Question Thimerosal Concern

Mercury-containing thimerosal has been used as a preservative in some vaccines since the 1930s. According to the Centers for Disease Control and Prevention, more than half a century later, there has been no evidence of any harm done to a child from thimerosal-containing vaccines.

Recently, however, an investigation stemming from the Food and Drug Administration Modernization Act of 1997 revealed that the cumulative level of mercury a child is exposed to in the first 6 months of life now exceeds guidelines set by the Environmental Protection Agency, although it does not exceed the limits of either the FDA or the CDC.

In response, the Public Health Service - supported by the American Academy of Pediatrics and the American Academy of Family Physicians - has called for manufacturers to reduce or eliminate thimerosal from their vaccines, and for physicians to take steps, particularly with regard to the hepatitis B vaccines, to minimize thimerosal use (MMWR 48[26]:563-65, 1999)

But, immunization experts believe that outside forces may have contributed as much - if not more - to the announcement as any legitimate concerns about mercury toxicity.

'The vaccines that contain thimerosal have either 12.5 or 25ug. A 6-ounce can of tuna contains 17 ug of mercury on average. Given that, 25 ug does not exactly blow you away,' said Dr Jon Abramson, new chair of AAP's Committee on Infectious Diseases.

However, once the cumulative mercury levels has been documented, 'the anti-vaccine groups would have accused us of hiding something if we had not gotten the information out quickly,' said Dr Abramson, chair of pediatrics at Wake Forest University, Winston-Salem, NC
Dr Richard Zimmerman, the AAFP's liaison to the CDC's Advisory Committee on Immunization Practices, agrees. Referring to the data used to set the mercury limits, he said. 'I'm not sure we have a convincing case. To extrapolate from studies of chronic fish ingestion in children in another part of the world to the spike-like nature of vaccine administration is a bit of a stretch.'

'I think this has a lot to do with issues of the media, and it might scare people. To my knowledge, no child has ever been harmed by thimerosal in vaccines,' said Dr Zimmerman of the department of family medicine and clinical epidemiology at the University of Pittsburgh. Nonetheless, manufacturers are taking the directive seriously. In a statement, the Pharmaceutical Research and Manufacturers of America (PhRMA) said that ' there is general consensus that it would be preferable to eliminate thimerosal from vaccines whenever possible. The vaccine industry is working closely with FDA and other government agencies to meet this objective.' Not all vaccines contain thimerosal. One of the four acellular pertussis vaccines and five of the eight Haemophilus influenza b (Hib) vaccines do not contain thimerosal.

'The greatest impact of the directive will be on use of the hepatitis B vaccine. It is the only vaccine recommended at birth and also the only one that protects against a disease for which young children are not immediately at risk.' Dr Abramson explained. All hepatitis B vaccines contain thimerosal except Comvax, which cannot be given prior to 6 weeks of age.

The recommendations say that infants of mothers who are positive for hepatitis B surface antigen (HbsAG), or of mothers whose status is not known, should still be vaccinated against hepatitis B at birth. However, for infants of HbsAg-negative mothers, the CDC and the AAFP recommend that the first dose of hepatitis B vaccine be postponed until they reach 2 months of age.

The AAP has gone a little farther. They recommend either that Comvax be used beginning at 2 months of age, or, if Comvax is not available, that the first dose of hepatitis B vaccine be postponed until the child reaches 6 months of age. 'That still allows for the child to receive all three doses by 18 months of age,' Dr Abramson said.

All groups recommend that premature infants of HbsAg-negative mothers not be vaccinated against hepatitis B until the infant has reached term gestational age and a weight of at least 5.5 pound.
Isabelle Claxton, spokes-woman for the vaccines division of Merck, said the company is accelerating production of Comvax, and will also make thimerosal-free pediatric single-dose Recombivax HB available by September. She does not anticipate these changes will significantly increase the cost of Merck's hepatitis B vaccines.

As for her feelings about the new recommendation, Ms Claxton agrees with Dr Abramson and Dr Zimmerman. 'Physicians should realize that the issue is not 'safety', but 'safer'. They have not been poisoning babies since 1930.' - From Pediatric News 33(8):1,7 1999, Miriam E Tucker, Senior Writer

(Article First Published in the International DAMS(Dental Amalgam Mercury Syndrome) Newsletter
Used with permission please contact Murlene Brake pbrake@sprynet.com

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