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The Vaccination Debate

Author: Bonnie Durrance
February, 2015 Issue

When it comes to childhood immunizations, what should parents know?

Wouldn’t it be wonderful to have someone discover the cause of autism? And not only that, but to find that to blame was something simple and easy to avoid—like childhood vaccinations?
In 1998, Dr. Andrew Wakefield, a British gastroenterologist, announced he’d done just that. He claimed that a study he conducted showed that the MMR vaccination (routinely given to prevent measles, mumps and rubella, and which has largely eradicated these childhood diseases from the population), caused autism. His announcement, offering the charm of an easy answer to an excruciating problem, ignited a movement against vaccines that’s grown and continues to this day—even after his “study” was proven fraudulent, even after he’d been stripped of his license to practice medicine, and even after the respected medical journal, The Lancet, which initially published the study, had denounced and removed it.
Now, more than 15 years later, resistance to vaccinations continues among some parents, diseases that hadn’t been seen in a generation are returning, and family doctors and public health officials are struggling to educate parents about the safety of vaccines and about the need for vaccines to keep the community healthy.

Life before vaccines

“Before the middle of the last century,” the Centers for Disease Control (CDC) in Atlanta reports, “diseases like whooping cough, polio, measles, Haemophilus influenzae and rubella struck hundreds of thousands of infants, children and adults in the United States. Thousands died every year from them. As vaccines were developed and became widely used, rates of these diseases declined until, today, most of them are nearly gone from our country. (Though, lest anyone think childhood diseases no longer pose a threat to the unvaccinated—no matter how privileged and informed—actress/director Angelina Jolie announced in December she would not be attending the premier of her movie, “Unbroken” because she'd contracted chickenpox.)
“Vaccinations completely changed the nature of childhood,” says David Witt, M.D., an infectious disease physician and chief epidemiologist at Kaiser Permanente in San Rafael. “‘Now I lay me down to sleep’ was a prayer of a child to awaken the next day,” he says, “which is the perspective of what life was like when people didn’t vaccinate.” That people would prefer the risk of disease to some imagined—and disproven—theory baffles and disturbs him.
“The autism connection is a completely debunked myth,” says Witt, “and yet it’s continued on by the likes of [comedian] Jim Carrey and [TV personality] Jenny McCarthy.” The celebrity couple, whose evangelical fervor on the subject was spurred by the suffering of McCarthy’s own autistic child, touted the bogus study in the media, urging parents to reject vaccines. Eventually, when the evidence mounted against them, they rescinded their claims. (They separated in 2010.) “She now says she doesn’t think her child’s autism is related to vaccinations.
“But still,” says Witt, with energy, “they drove this for years.” He sees the 2010 deaths of 10 children in California, of pertussis, as a result of ill-advised failure to vaccinate. “That’s just inexcusable in a modern country,” he says.
To him, it’s simply amazing that people who read about and “research” vaccines would ultimately listen to celebrities instead of reliable sources, such as the American Academy of Pediatrics, the Centers for Disease Control or even their own pediatrician. But, he allows, there are factors that may make their skepticism understandable—including the success of the vaccines themselves.
“I think one of the things that drives the misinformation is that people don’t see these diseases: ‘Why do I have to be vaccinated for measles, because I don’t know anyone who’s ever had measles?,’ he says. “There’s some relative truth to that—except for when you travel. And in the North Bay, we’re in a fairly prosperous community, so many of us will be traveling to countries where some of these diseases are endemic. Those travelers have the risk of being exposed.
“We’ve already had a couple hundred cases of measles in the United States this year, and it’s an ugly disease.” Measles brings with it a risk of encephalitis, brain damage, respiratory problems and death, which is why it’s dangerous to have it making a comeback here—especially when, in other, fully vaccinated countries, it’s completely absent. “It’s kind of an embarrassment, I think,” Witt concludes.

What do vaccines do?

“Vaccines are designed to mobilize the body’s natural defenses against an infectious agent,” says Jennifer Henn, Ph.D., public health epidemiologist for the Napa County Public Health Division. “For example, the influenza vaccine, the one that’s given in a shot form, contains a flu virus that’s been killed. When you introduce that to your body, you’re stimulating your immune system without the risk inherent in being exposed to the actual disease.”
The vaccine, in other words, introduces a harmless form of a virus, either weakened or dead, that the body then will recognize and generate the antibodies to be ready to fight, should you be exposed to the disease. “And,” says Henn, “this is important: The vaccine cannot give you the disease.”
That’s not to say there can’t be individual adverse reactions to the vaccine, nor that certain vaccines aren’t unsafe for people with some conditions, such as those undergoing cancer treatment, for example. “Some people do have reactions to the vaccines,” says Henn. “The most common is a temporarily sore arm. Less common would be feeling fatigue or having a low-grade fever. When we hear reports about people who say, ‘Oh, I got a flu shot and a day later, I came down with a high fever, cough and a sore throat,’ that’s most likely not from the vaccine. It’s probably that you’d already been exposed to something and were going to get sick anyway.”
Since the 1998 claim, all studies have shown that autism is not one of the possible reactions to vaccinations. And yet, the suspicion continues. “I think many people who were concerned about the link between vaccines and autism, even though they know it’s been discredited, still have lingering fears about vaccines. It may not be specific to autism. It may just be fears that the vaccine can cause a side effect in their child.”
Henn urges that parents who are having questions or hesitations about vaccinating their child for any reason should go straight to the experts: Talk to a pediatrician they trust and get that doctor’s opinion. “Pediatricians are often parents, too,” she says. “They’re vaccinating their children and they see the children that they give the vaccines to. They have that first-hand experience.”

Ask your doctor…please!

Marjorie Bohn, D.O., Sutter Pediatrics, with Sutter Medical Group of the Redwoods in Santa Rosa, answers questions from parents regularly on the safety of and need for vaccines. She says it’s natural for parents to have questions and to want to protect their child as best they can. She’s eager to dispel the misinformation that circulates in the media and the Internet.
“It’s amazing what we can find on the Internet,” says Bohn. “It can be easy for anyone to be misled, and the misinformation spreads. It’s our job to help parents understand the fact versus the myths. Vaccines are safe, necessary and lifesaving. The vaccine schedule that we, as providers, recommend is based on up-to-date guidelines published by the Advisory Committee on Immunization Practices, a national group of medical and public heath experts. Our job is to educate parents on how to promote infant and child health and well-being; vaccines are an important part of preventive care.”
The proliferation of unqualified information presents a continuing challenge to doctors. “We continue to work hard to guide parents to the right information,” she says. “I feel it’s important to ask each parent about concerns he or she might have at each visit.”
“Those rumors have been going around for more than 15 years,” says pediatrician Jerome Smith, M.D., MPH, FAAP, member of Prima Medical Group in Sonoma. “So it’s going to take us decades to undo that erosion of trust.” Smith maintains a regular schedule of vaccinations to protect his own 20-month-old twins, Luke and Diego, from the diseases that are now, thanks to vaccines, mostly removed from our communities. He advises the same for his patients. “Vaccines save lives,” he says, “And despite Internet pseudo-science to the contrary, there’s a large body of evidence and a lot of vigorous testing that backs that up.”
Yet, given the wide assortment of information available from sources both reliable and unreliable, parents may become confused about whom to trust. “I think we no longer take trust for granted,” says Smith. “There’s so much misinformation out there that we have to earn that trust. We assure parents that, in pediatrics, we have their child’s best interests at heart. That’s why we went into the field—to take care of their children.”
Parents who want to do their own research need to know that there’s critically reviewed and trustworthy information on the Internet that they can access to feel comfortable about the decision of how and when to vaccinate their children. He recommends the American Academy of Pediatrics and also the Centers for Disease Control, both of which have reliable, vetted information on their websites.

A public health issue

“In public health, if we’re doing our jobs well, people don’t know it because they’re not getting sick from these diseases,” says Henn. “Part of the problem is that when people don’t see the disease, they don’t see the risk. It makes the vaccine seem potentially more dangerous than the actual disease.”
As an example, in Napa County, about 93 percent of entering kindergarteners have received all of their required vaccinations. It’s because of that high number that we don’t see outbreaks of these diseases. But the diseases still exist. The only disease that widespread vaccination has eliminated completely is small pox. Other diseases, like measles, mumps, rubella and diphtheria, still cause tens of thousands of cases of illness in Africa and Southeast Asia every year. “Infectious diseases don’t know borders,” Henn reminds. “If your child isn’t vaccinated, he or she is at risk of getting an infectious disease should that disease come into this country.”
Not only is the unvaccinated child at risk of developing a disease and exposing others in the community, but he or she is also at risk of losing school time if exposed to someone with the disease. “A lot of times, the school is going to ask that child to stay home for the number of days required to pass the incubation period,” says Henn. “Not vaccinating also has consequences in terms of missed school and missed work days for parents. Their child would potentially be excluded from school should an exposure occur. That would not be true for vaccinated children.”
She says the county helps to make sure children are able to get their vaccines easily. “We don’t want any child to not be vaccinated because they don’t have enough money or they don’t have health insurance. We offer the VFC program [Vaccines for Children] here at the county offices, and we have vaccines to give to children whose parents either can’t afford the cost or who have Medi-Cal. That’s making sure those kids get vaccinated on schedule so they can enter school on time, and that they have the same health protection to which everybody is entitled.”
For Witt, vaccination represents not a private right of choice, but a community responsibility. In a vaccinated population, disease cannot gain a foothold, but in an unvaccinated population, disease can proliferate. “Think of a forest fire,” he says. “If the forest is very sparse, it can’t burn. You need a certain density of trees to perpetuate a fire. So when we see outbreaks of disease, like we’ve seen with measles, it tends to be in schools with an unvaccinated population—often alternative schools. Measles is the most contagious disease we know of, and it spreads like wildfire. Thankfully, it’s mostly not here. And polio is almost gone from the world, except for three countries.”
“I think it shouldn’t be so easy to opt out of vaccination,” he says. “I think this is a societal decision, that we need to protect all of us. And until very recently, you had to be vaccinated to go to school.”
Parents can refuse vaccinations for their children on “religious or philosophical” grounds, but a new law, effective January 1, 2014, requires them to bring to school a document signed by themselves and a health care professional indicating they’ve been informed about vaccination and have chosen against it. For Witt, infectious disease isn’t an area where personal preference should hold sway over the common good. “It’s really not an issue of individual choice, where ‘I have the right to put my child at risk.’ It’s just not your right to put the community at risk. It’s your duty to be vaccinated. If we’re all vaccinated, we’re all protected. And I think folks need to realize the severity of these illnesses.”
For him, it’s not a comfort that most of these diseases are endemic elsewhere, and we’re protected by their absence in this country. “If the recent ebola scare has taught us anything, it’s that this is a global world.”

Vaccinations Work

• Nearly everyone in the United States contracted measles before there was a vaccine, and hundreds died from the disease each year. Today, most doctors have never seen a case of measles. 
• More than 15,000 Americans died from diphtheria in 1921, before there was a vaccine. Only one case of diphtheria has been reported to CDC since 2004.
• An epidemic of rubella (aka German measles) in 1964-65 infected 12.5 million Americans, killed 2,000 babies and caused 11,000 miscarriages. In 2012, nine cases of rubella were reported to CDC.

Herd Immunization

Under the California School Immunization Law (California Health and Safety Code, Sections 120325-120375), to protect the public’s health, children are required to receive certain immunizations to attend public and private elementary and secondary schools, child care centers, family day care homes, nursery schools, day nurseries and developmental centers.
This collective or “herd” immunization is a way of safeguarding all—even those who, for a variety of reasons, cannot avail themselves of vaccinations. There are four ways that others in the community may be harmed by a parent’s decision not to immunize his or her child:
• If the unimmunized child gets a preventable disease, he or she can pass that disease to other unimmunized people in the community.
• Even when people are immunized, there’s always a small percentage of them for whom the vaccine didn’t work or whose immunity has waned; so these people will also be at increased risk if an unimmunized child contracts a preventable disease.
• If a person cannot receive vaccines for medical reasons, he or she relies on those nearby for protection from the diseases.
• Families that have received vaccines yet contract a vaccine-preventable disease from an unimmunized person will need to pay the medical costs incurred by the disease. Treatment for these diseases cost much more than the vaccines, so the unimmunized child’s family or society will bear these costs.

Losing Sight of What’s Right

Misinformation leading to nonvaccination can leave people vulnerable to disease, but there’s another consequence of the hoax about the connection between vaccines and autism. “The crusade to prove that vaccinations cause autism is detracting funding for actually finding the cause of autism,” says Dr. Witt. “We’ve spent so much money disproving the same thing over and over again—money that could have been used to find something useful to help families affected by autism.”


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