Childhood Immunization: Can’t Let Your Guard Down

Mike Magee

As the recent outbreak of whooping cough in California illustrates, ensuring population wide immunization remains an uphill battle.

The story of childhood vaccinations, at least in the developed world, is a remarkably successful one. With the development of vaccines, many childhood diseases have become extremely rare, and the health and well-being of millions of people have been dramatically improved.(1)

So why is it that so many parents these days are reluctant to vaccinate their children? Is the new complacency – and outright opposition to vaccinations — warranted? Is there some reason why we should back off from the generally accepted medical practice of vaccinating our kids?

The answer to all these questions is a firm “no” – and for the next few minutes we’ll explore why vaccinations are still a good idea. But first, let’s have a look at the statistics on vaccinations and childhood disease.

According to Dr. Louis Z. Cooper of the American Academy of Pediatrics, “The overall number of children who contract preventable diseases is down 99 percent since the early 1970s. Still, if even one child dies from an easily preventable disease, its one child too many.”(1)

There are now 13 vaccine-preventable diseases: diphtheria, haemophilus influenzae type B, hepatitis A and B, measles, mumps, pertussis, pneumococcal pneumonia and meningitis, polio, rotavirus, rubella, tetanus, and varicella (or chickenpox).(2) This has been accomplished thanks to individuals and communities that have helped us reach our current childhood immunization coverage levels. In 2004, 83 percent of U.S. children age 19 to 35 months were up-to-date on their shots, compared to 76% in 1996.(3)

What do these shots do? They introduce the child’s immune system to a harmless portion of the microorganism for each disease. Having been exposed, the immune system gears up to destroy any real offenders that may be encountered in the future.While individual immunity is extremely important, “community immunity” is critical from a public health perspective.(1,4) The higher the numbers of protected citizens, the less likely a disease will spread from child to child and cause an epidemic. We know from experience that complacency when it comes to getting vaccinations can lead to disaster. For example, in the early 1960s, measles caused 48,000 hospitalizations and 3,000 deaths a year among U.S. children. With licensure of the vaccine in 1963, the number of cases was rapidly reduced by 99 percent. Then, around 1990, measles immunization rates dropped. As a result, 55,000 new cases were reported, with 11,000 hospitalizations and 125 deaths.(1)

Complacency and opposition to childhood vaccination is a direct result of misinformation. For example, many believe that the diseases I just mentioned, or, more accurately, the microorganisms that cause the diseases, are gone forever. This is an extremely dangerous misconception. The offending agents are all around us, but with most of the population protected, they are unable to spread from human to human. To truly appreciate the risk experienced by unprotected populations, take a look at statistics from the developing world. More than 2 million people a year, mostly children, die from vaccine-preventable diseases.(5) We can’t allow ourselves to think vaccines “aren’t worth it” because we’re afraid of side effects or because we think we’re safe from disease. It’s the exact opposite. As Professor Stanley Plotkin from the University of Pennsylvania notes, “In developed countries, we no longer have infectious diseases for which there are vaccines, so the risk of the vaccine is perceived to be greater than the risk of the disease. But that is true because the vaccine is being used.”(5)

The story of polio carries the same lesson about complacency. According to pediatrician Neil Herendeen from Strong Memorial Hospital at the University of Rochester, “In the 1950s, polio affected every neighborhood. Now natural polio is far removed from most people’s daily lives. But when a little girl in California develops side effects from polio vaccine, that hits the newspapers.”(5)

I remember well those scary days of the 1950s — I was one of the children who contracted polio. Once the vaccine became available, my father volunteered, along with many other physicians, to mass vaccinate all school children. The threat of the disease at that time was palpable, and the benefits of the vaccine were clear.

Today, on the other hand, there are a lot of misconceptions about vaccines. In an effort to debunk the myths, organizations like the Centers for Disease Control and Prevention provide accurate, easy-to- read information on their web sites. Let’s take a few of the myths one by one.

Myth: Vaccines cause many harmful side effects, illnesses and even death.

The Truth? Vaccines are remarkably safe and effective. Each one undergoes about 10 years of research before it’s approved by the FDA. After it’s approved, safety monitoring for side effects continues. Most side effects are minor and temporary, such as a sore arm or minor fever.(6)

Myth: Disease is rare in the United States, so there’s no need to be vaccinated.

The Truth? We live in a global society that creates many opportunities every day for the reintroduction of microorganisms into our communities. Experience tells us that when immunization rates fall, diseases rapidly reappear.(6)

Myth: Giving multiple vaccinations at the same time – like MMR for measles, mumps, and rubella – increases the risk of side effects.

The Truth? Studies show no increased risks with combined vaccines. This is logical, since our bodies are used to being simultaneously challenged by multiple germs of differing types. Grouping vaccines together increases the likelihood of reaching acceptable levels of community-wide immunity.(6)

Myth: Even if you’re vaccinated, you can get the disease, so it’s not worth the trouble.

The Truth? Childhood vaccines are 95% effective in providing long-term immunity. The best protection for the 5% whose bodies don’t respond to vaccination is high immunity levels in the community to make it unlikely they will be exposed to the disease.(6)

Myth: The DTP (diphtheria, tetanus, and pertussis) vaccine causes sudden infant death syndrome, or SIDS.

The Truth? While both occur in the same time frame of an infant’s life, multiple studies have found no evidence of any causal connection.(6)

Myth: Measles vaccine causes autism.

The Truth? There is no evidence of a causal association. A study of 530,000 Danish children, the results of which were published in The New England Journal of Medicine, found that rates of autism were no different among vaccinated and unvaccinated children.(7)

The bottom line is, any risks that might be associated with vaccination are minor when compared to the benefits. The American Academy of Pediatric’s Dr. Cooper puts it this way, “Not fully immunizing children is one of the most serious and potentially fatal mistakes a parent can make with a child’s health.”(1)

It doesn’t get any clearer than that.

For HealthCommentary, I’m Mike Magee.

References

1. American Academy of Pediatrics. “Vaccines continue to be vital in protecting children’s lives.”
Available at: http://www.aap.org/advocacy/releases/vaccines.htm.

2. Centers for Disease Control and Prevention National Immunization Program. “Vaccine- Preventable Childhood Diseases.” Available at:http://www.cdc.gov/vaccines/vpd-vac/child-vpd.htm

3. America’s Children In Brief: Key National Indicators of Well-Being, 2006. “Health.” Available at:
http://www.childstats.gov/.

4. National Network for Immunization Information. “Immunization Issues: Community Immunity.”
Available at: http://www.immunizationinfo.org/immunization_issues_detail.cfv?id=26.

5. Lewis R. Vaccines: Victims of their own success? The Scientist. 2004;18:15. Available at:
http://www.the-scientist.com/article/display/14828/.

6. Centers for Disease Control and Prevention National Immunization Program. “Six Common Misconceptions.” Available at:http://www.cdc.gov/vaccines/vac-gen/6mishome.htm

7. Madsen KM, Hivid A, Vestergaard M, Schendel D, Wohlfahrt J, et al. A population-based study of measles, mumps, and rubella vaccination and autism. NEJM. 2002: 347:1477-1482.