How many parents would allow their two-year-old to play in the street alone because they wanted the child to learn from experience to avoid dangerous situations? I suspect the answer is zero to none. And yet some young parents who have not experienced the illnesses for which we immunize elect to decline this life-saving technology for their children. In most instances a child left to play in the street would not be harmed because cars would avoid hitting her or she would run back to the safe yard. But why take a chance? Wouldn’t it be better to teach the child to stay out of the street even if they cried because they wanted to stay in this dangerous environment?
Although the recurrence of childhood diseases is more of a problem in other areas of the US, such as California where the recent Disneyland experience has led to an outbreak of measles around the country, we do have whooping cough and other childhood diseases here in Lincoln and Nebraska.
What are the reasons for avoiding immunizations that can prevent life-threatening illness?
First, there is a cadre of young parents who perceive that “the natural way” is the healthiest approach to raising children. Sometimes natural consequences are the most effective way to modify children’s behavior, but no one would let their child touch a hot stove to learn to avoid it in the future. There is often a grain of truth in any undocumented perspective, such as that unprocessed foods are probably healthier than highly processed foods, but there is also a sound basis for feeding children the former.
Second, there is a fear of horrible side effects of immunizations. In truth, there are rare harmful consequences of any medication or substance that we put in our bodies. It is always a matter of the risk/benefit ratio. In the case of immunizations, there is clear scientific documentation that the latter by far exceeds the former. In spite of extensive research prior to placing a given vaccine on the market, fear still exists on the part of parents. This is brought about by hysterical media reports that have not looked into the issues at hand in depth. A number of years ago in the United Kingdom the pertussis (whooping cough) vaccine was reported to cause brain damage. The subsequent reaction in which parents declined the vaccine resulted in numerous deaths and illness from children having the disease. Although there may have been rare instances of harm from the immunization, here again the benefit far exceeds the risk.
As a child I had this disease, which didn’t kill me but merely ruined my summer. I would cough and cough until I vomited, only to have this scenario repeat itself in a few hours. However, in very young babies it can cause convulsions, pneumonia, and in some cases, death.
In recent years in California and other states whooping cough still occurs. Thousands of cases have been reported in the past few years with deaths.
It spite of these mini-epidemics, a report at the Pediatric Academic Societies annual meeting noted that in Washington state immunization rates did not increase following an outbreak of whooping cough. It appears that this even when it is close to home, many parents still fail to immunize their
One of the problems with this illness is that an infant needs to be two months old before the vaccine “takes,” thus there is the time period after birth that the child is vulnerable to becoming ill. If there is a low incidence of immunity in a community, the potential for exposure rises, and these infants contract the disease at a time when they are more likely to become seriously ill, as noted above.
In recent years, a more refined vaccine has been developed that has many fewer side effects.
The old whole-cell vaccine did have more minor reactions, such as fever, but it is questionable whether or not it did in reality cause brain damage. Cognitive impairment is not always apparent in the first few months of life. Because we immunize during the first year, the timing of such and the recognition of brain problems occur at about the same time, and thus parents may assume there is a causal effect. The scientific caveat that correlation does not necessarily mean causation is relevant here, i.e., just because two events occur at the same time does not mean that one caused the other.
The same can be said of the supposed relationship of measles, mumps, and rubella vaccine. Because at one time this combination contained mercury as a preservative, a report in the prestigious medical journal Lancet implicated the vaccine as a cause of autism. However, this has been disproved and the author removed from the medical registry in the UK because of fraud. In spite of this and the removal of mercury from all but one of the vaccines, the fear among the public still exists and is another reason why a few parents are reluctant to immunize their kids.
The products that protect our children go through stringent and multiple evaluations before they are placed on the market. In fact, even after the vaccine has been used for many years, a reevaluation occurs on a regular basis as to the need to continue giving it. An example is that of the first disease that was eliminated—smallpox. Smallpox was a scourge for thousand of years, accounting for many deaths. Native American tribes were nearly eliminated by coming into contact with Europeans who had more immunity than they did. A former senior associate of mine in Lincoln told me that in the early part of the twentieth century, when a child was admitted to Allegheny General Hospital in Pittsburgh, they routinely were given the vaccination because of the widespread incidence of the disease. However, because there is no animal host for the disease and because of aggressive universal immunization, by 1948 the disease had been eliminated in the USA. As a result, my mentor at the University of Colorado Medical School, Dr. Henry Kempe, successfully proposed the discontinuation of universal smallpox vaccination. He did so in part because he saw children suffer from generalized vaccinia, a condition seen in children who had unrecognized immune deficiencies and usually died. Of course, nowadays because the disease has been eliminated throughout the world, no one is vaccinated. This is an example of reassessing the need for an immunization.
A somewhat similar situation occurred with the oral polio vaccine when it was discovered that, in extremely rare instances, one could contract polio from the live vaccine. As a result, in developed countries we use a killed product. The oral polio product is used in developing countries because of the ease of administration. There are only three countries where polio still exists: Nigeria, Pakistan, and Afghanistan. The elimination in the rest of the world is largely due to efforts of Rotary International and the World Health Organization. Rotarians have diligently contributed the money to make this possible and continue to do so with their Polio Plus program. However, outbreaks do occur in other countries because of the ease travel, thus indicating the need to continue to crush the disease in the three endemic countries
It is of interest to note that an obstacle to completing the task in the world is that Islamic Mullahs in some areas have convinced their flocks that immunizing the children is a Western plot to sterilize them. Rotarians from Lincoln who have been involved in National Immunization Days sponsored by Rotary International have reported vaccine refusal by mothers in Islamic countries. Some time ago in Pakistan five health-care workers were killed by the Taliban for distributing polio vaccine.
India was polio free last year, but outbreaks have occurred in China, Cameroon, and Tajikistan from cases carried to these countries. The 87 percent immunization rate in the latter was insufficient to prevent the recurrence. At least a 90 percent rate is needed to provide “herd immunity” to prevent the spread. When this level of immunization is present, the given disease is unlikely to spread. Thus, parents who do not allow this protection not only place their own kids at risk but those of other families.
The success of ridding modern society of dreadful diseases is another reason for the neglect of immunizing children. For someone my age who experienced polio in his classmates, it is inconceivable that parents wouldn’t take this low-cost practice to protect their kids. However, they just haven’t had the experience. Personally, I had many of the less serious illnesses and was treated for almost all the others, so it is easy for me to believe in these modern-day miracle prevention strategies.
What is interesting is that it is the better “educated,” more affluent parents that distrust the practice. Is it because they have better access to the Internet, which is a great source of information but an equal source of misinformation? One of my patients a few years ago told me that he had “researched” the subject of the harmful effects and found several sites that decried the procedures. He should have said “searched” instead of researched because there is a huge gulf between the two.
However, there are a variety of excellent sources on the Internet that can provide accurate information as to the value and safety of vaccines. They are listed at the end of this
I can’t help but believe that the media contributes to the misinformation because there is the need to come up with the latest “exposé.” John Stossel of Fox News has indicated that this is one of the reasons he left ABC. Occasionally this information is helpful, but it often exaggerates problems and simply worries folks with no benefit. What is reported as a controversy often is that a few “wing nuts” are given equal time with true authorities and it is made to seem that there is justifiable debate on the issue. Often the reporters are not versed in scientific writing and mislead the public.
Some physicians are not without blame here. Most recently that “expert” on all health issues, cardiovascular surgeon Dr. Mehmet Oz, told his audience that he had modified the recommended immunization schedule for his own children and suggested it was “okay” for others to do so. The American Academy of Pediatrics, one of the best sources for information on children’s health, strongly criticized his recommendations. One of the reasons for such, as I noted above, is that babies need protection early, especially from pertussis. The effect on the respiratory tree is that thick mucus is produced that cannot be removed by the cough. The result is a continuous cough, often followed by vomiting, producing enough force to finally eject the thick substance. If the latter is not removed, pneumonia may result. Convulsions may also occur because of the paroxysms. Death in the very young is not uncommon.
Not all of the complications of the vaccine-preventable diseases can be discussed here, but suffice it to say that most can cause death, if not a miserable experience resulting in time lost from school and from work for parents who need to stay home with their sick kids.
The parent above who refused to immunize his children also indicated to me that drug companies and doctors formed a conspiracy to encourage immunization. To a doctor who is dedicated to keeping kids healthy, this seems unimaginable. Thus, we are left with an unfortunate situation that needs a solution. I think the health profession could do a better job of informing parents about the diseases that vaccines prevent before they hear of the rumors and misinformation so prevalent. Schools could also do the same for children.
Nevertheless, often our decisions are based on emotion, and reason doesn’t always trump the former.
The following is a statement by the American Academy of Pediatrics:
Vaccines are among the most safe and effective public health interventions to prevent serious disease and death. Because of the success of vaccines, most Americans today have no firsthand experience with such devastating illnesses as polio or diphtheria. Health care providers who vaccinate young children follow a schedule prepared by the U.S. Advisory Committee on Immunization Practices. Under the current schedule, children younger than six may receive as many as 24 immunizations by their second birthday. New vaccines undergo rigorous testing prior to receiving FDA approval; however, like all medicines and medical interventions, vaccines carry some risk.
Driven largely by concerns about potential side effects, there has been a shift in some parents’ attitudes toward the child immunization schedule. HHS asked the IOM to identify research approaches, methodologies, and study designs that could address questions about the safety of the current
This report is the most comprehensive examination of the immunization schedule to date. The IOM committee uncovered no evidence of major safety concerns associated with adherence to the childhood immunization schedule. Should signals arise that there may be need for investigation, however, the report offers a framework for conducting safety research using existing or new data collection systems.
Thus far I have said little about adult immunizations. These are equally important for they can prevent adult diseases such as shingles and pneumonia. If children come down with shingles, they often recover uneventfully, but for adults it is a different story. This disease, caused by the latent chickenpox virus, can result in a long-term, debilitating illness. Lincoln’s own Dr. Bob Rauner has shown that hospitalizations for pneumonia can be reduced by systematic immunization for the pneumococcal germ, one cause of pneumonia.
Recent research has demonstrated that immunizations have resulted in cost savings as well as reduced hospitalizations and deaths. At a time when health-care costs are skyrocketing, we need all the strategies available to impact this drain on the economy.
What should the reader do about this important issue? If you have children, learn the truth from reliable sources such as your personal physician and then have your children immunized. If you are a grandparent, discuss immunization with the parents, and if they are hesitant, reassure them of the safety of these life-serving products. For other readers, learn the facts and then debunk the misinformation that abounds on the Internet and other questionable sources.
As to those few folks that absolutely refuse to have their children vaccinated, it is probably futile to argue with them. What is important is that those that are vacillating whether or not to immunize their children should be strongly encouraged to do so. If we get to 95 percent immunization rate, we can protect those that are at risk and prevent the spread.
More information on the American Academy of Pediatrics can be found at http://www.aap.org and on immunization at http://www2.aap.org/immunization/.