Should you immunize your children?

As adults, most of us have childhood memories of those trips to the doctor’s office when we’d hear those words, "You'll hardly feel a thing", or "It won't taste that bad." For most of us it did hurt and yes, it did taste bad, but those vaccines that we were receiving through inoculations or tiny cups of not so tasty liquids, were just a part of life. They were what kept us from succumbing to innumerable diseases, some even contagious. And that lollipop from the doctor or a kiss from Mom wherever it hurt almost always wiped away any memory of any little needle prick.

Things are not as simple today. Despite the many benefits of vaccines, the last few generations of parents have been much more skeptical, questioning just how necessary the vaccinations are and whether or not they have dangerous side effects.

According to Donald G. McNeil, Jr., in his March 29th article in The New York Times, "Public health experts generally agree that after clean water and flush toilets, the most important health advances in history have been vaccinations." He goes on to say that "Shots against measles, diphtheria, whooping cough (pertussis), tetanus, polio, mumps, rubella, chicken pox, flu, hepatitis and some causes of childhood meningitis, pneumonia and diarrhea have saved more lives than all the "miracle drugs" of the latter half of the 20th century - antibiotics like penicillin, antiviral-like drugs to fight AIDS and flu, and so on. In addition, vaccination is one of the leading reasons that many families in the West now feel comfortable having only two or three children: they can be reasonably certain that the children will survive childhood."

An historical study by the Centers for Disease Control and Prevention (CDC) released in November of 2007 states that death rates for 13 diseases that can be prevented by childhood vaccinations were at all-time lows in the United States. The study included hospital and death records going back to 1900. In nine of the diseases, rates of hospitalization or death had declined more than 90 percent. For 3 - smallpox, diphtheria and polio - death rates had dropped by 100 percent. Smallpox vaccine is no longer given to children because the disease has been eliminated.

With those statistics, one would think that the case for having our children vaccinated would be strong enough that there would be no need for discussion, but that is not the case. Since the 1990's, vaccines have become more and more controversial. The New York Times article explains the change this way:"As diseases have disappeared, generations have grown up without ever seeing the sickness and death they caused. At the same time, new parents are often upset as their babies receive 20 to 30 injections before age 2 and suffer the mild fever that can accompany them as routine side effects."

In addition, rumors continue to spread that some vaccines, or a preservative added to vaccines, may cause autism. The man who fueled that rumor, Andrew Wakefield, a British scientist in the area of gastroenterology, announced at a press conference in 1998 that his research had led him to have concerns about the safety of the measles-mumps-rubella vaccine (MMR) and its relationship to the onset of autism. Although he did not claim to have proved that the vaccine caused autism, word of his concerns quickly spread around the world. His belief, according to Susan Dominus of The New York Times, based on a paper that he wrote about 12 children, is that the three vaccines, given together, can alter a child's immune system, allowing the measles virus in the vaccine to infiltrate the intestines; with certain proteins then escaping the intestines, and then being able to reach and harm neurons in the brain.

Few theories have drawn so much attention, and so much refutation. In 2003, The Archives of Pediatrics and Adolescent Medicine, which reviewed more than a dozen epidemiological studies, concluded that there was no evidence of an association between autism and MMR, and studies in numerous other medical journals have come to the same conclusion. In Britain, Andrew Wakefield's medical license has been revoked, citing numerous ethical violations that tainted his work. The Lancet, which published the original Wakefield paper, has since retracted it. Andrew Wakefield has become one of the most reviled doctors of his generation, blamed directly and indirectly for irresponsibly starting a public panic with tragic repercussions: vaccination rates so low that childhood diseases once all but eradicated here – whooping cough and measles, among them – have re-emerged, endangering young lives.

Recently, the Associated Press released news that a measles outbreak had hit Europe, most of the cases being in France, and the World Health Organization blames it on a lack of vaccinations. France had 4,937 reported cases of measles between January and March, compared with 5,090 for the whole of 2010. In all, more than 6,500 cases have been reported this year in 33 European nations.

Rebecca Martin, head of the WHO's office in Copenhagen for vaccine-preventable diseases and immunization, reports that "There's been a buildup of children who have not been immunized over the years. It's almost like a threshold. When you have enough people who have not been immunized, then outbreaks can occur." WHO has found that young people between 10 and 19 have not been getting immunized as they should. To prevent outbreaks, officials need to vaccinate about 90 percent of the population, but vaccination rates across Europe have been patchy in recent years. Parents abandoning the idea of vaccinations in droves have driven the rates down by about 50 percent. The disease has become so widespread in Europe in recent years that travelers have occasionally exported the disease to the U.S. and Africa. WHO said outbreaks and rising case numbers also were reported in Britain, Germany and the Netherlands.

In the U.S., the United Press reports that a significant amount of primary care physicians' time during a well child visit is spent discussing child vaccine safety with parents. Dr. Allison Kempe, a professor of Pediatrics at the University Of Colorado School Of Medicine, director of the Children's Outcomes Research Program at The Children's Hospital, reports a national survey indicates a majority of physicians think parents' level of concern about vaccines has either greatly or moderately increased in the last five years.

The study, published online ahead of print in the May issue of American Journal of Preventive Medicine, finds in a typical month, 79 percent of physicians report at least one vaccine refusal, 8 percent report refusals for more than 10 percent of children, and 89 percent report at least one request to spread out vaccines. The study also indicates 40 percent of physicians always or often require parents to sign a form if they refuse a vaccination. Most physicians would agree to spread out vaccines in the primary series at least sometimes. Approximately 10 percent of physicians would often or always dismiss families from their practice if they refuse vaccines in the primary series and another 5 percent would sometimes do it.

For a child attending school here in Odessa, do not hesitate to speak to your primary care physician about your child's vaccinations, but remember, there is another resource open to you: Jolene Erickson, nurse for the Odessa Schools. Her hours are limited, but you can make an appointment to get answers to your questions.

Without a waiver, children entering school for Preschool or Daycare must have proof of vaccinations for Hepatitis B, Diphtheria, Tetanus, and Pertussis (DTaP/DT), Hoemophilus Influenza Type B (Hib), Polio (IPV), Pneumococcal Conjugate (PCV), Measles, Mumps, Rubella (MMR), and Chickenpox (VAR). For grades K-12, children must show proof of vaccination for Hepatitis B, DTap/DT, Should you immunize your children?, MMR, and VAR. All schools in Washington are also required to provide parents or guardians with information on Meningococcal disease and Human Papillomavirus (HPV) for students entering grades 6-12.

That seems like an overwhelming list of shots for a young child, but the CDC offers this list of questions to ask your primary care physician if you have concerns:

1) Is it okay for my baby to have so many shots at once?

2) Don't infants have natural immunity?

3) Haven't we gotten rid of most of these diseases in this country?

4) Can't I just wait until my child goes to school to catch up on immunizations?

5) Why does my child need a chickenpox shot? Isn't it a mild disease?

6) Where can I get more information?

It is important to remember that the discussion about immunization is not just about toddlers. As you can see by the schools’ requirements, proof of vaccinations continues through high school, and adults require booster shots for certain vaccines as well.

So after you have discussed your youngest child's vaccinations with your primary care physician, what else should you ask? The New York Times gives us this list:

1) What vaccines does my teenager need?

2) Does my teenager need a chickenpox booster?

3) What new vaccines does my child need?

4) Should I get my child a thimerosal-free flu shot?

5) As an adult, what shots do I need?

6) What if I'm pregnant?

7) Do you send reminders out about boosters or other immunizations?

8) Do I need the vaccine against shingles?

9) Do I need any other vaccines if I'm over 50?

10) What vaccine side effects should I look out for?

11) What if a bad reaction occurs?

More vaccinations are being developed every day, especially those aimed at teenagers to thwart diseases spread by sex or are common in student dorms or military barracks. Newer vaccines tend to be much more expensive than older ones, which were developed before the era of clinical trials costing hundreds of millions of dollars and before medical liability lawsuits were so common. But before you worry about those costly lawsuits, take into account the recent Supreme Court ruling that protects vaccine makers. Robert Barnes of The Washington Post writes, "Federal law protects pharmaceutical companies from lawsuits by parents who claim that vaccines harmed their children, the Supreme Court ruled Tuesday. The court ruled 6 to 2 that going before a special tribunal set up by Congress is the only way parents can be compensated for the negative side effects that in rare instances accompany vaccinations.

The majority said that Congress found such a system necessary to ensure that vaccines remain readily available, and that federal regulators are in the best position to decide whether vaccines are safe and properly designed.

The National Childhood Vaccine Injury Act of 1986 "reflects a sensible choice to leave complex epidemiological judgments about vaccine design to the FDA and the National Vaccine Program rather than juries," Justice Antonin Scalia wrote, referring to the Food and Drug Administration.

Justices Sonia Sotomayor and Ruth Bader Ginsburg dissented, saying the threat of lawsuits provides an incentive for vaccine manufacturers to constantly monitor and improve their products.

The decision is a victory for vaccine makers such as Wyeth and GlaxoSmithKline. Kathleen Sullivan, who represented Wyeth in the case before the court, told justices that ruling against the company could lead to thousands of lawsuits in which parents claim, for instance, that the mumps, measles and rubella vaccine played a role in their children's autism.

"The Supreme Court decision protects children by strengthening our national immunization system and ensuring that vaccines will continue to prevent the spread of infectious diseases in this country," AAP President O. Marion Burton said in a statement.

So why should you have your children immunized? It's true that some diseases like polio and diphtheria are becoming rare in the U.S., but that is largely because we have been vaccinating against them. Like the resurgence of whooping cough, if a generation or two are not vaccinated, the disease returns. According to the CDC, in 1974, Japan had a successful whooping cough (pertussis) vaccination program with nearly 80 percent of Japanese children vaccinated. That year, only 393 cases of pertussis were reported in the entire country, and there were no deaths from pertussis. But then rumors began to spread that pertussis vaccination was no longer needed and that the vaccine was not safe, and by 1976 only 10 percent of infants were getting vaccinated. In 1979 Japan suffered a major pertussis epidemic, with more than 13,000 cases of whooping cough and 41 deaths. In 1981 the government began vaccinating with acellular pertussis vaccine, and the number of cases dropped again.

So what would happen if we stopped vaccinating? Diseases that are almost unknown could stage a comeback. We are currently witnessing the resurgence of pertussis in Lincoln and neighboring counties. (See related article, page 3). Could we see epidemics of diseases that are nearly under control today? The cost of keeping up to date on all of our vaccines throughout our lifetime may indeed prove to be expensive. But the cost of not vaccinating at all, as history has taught, can be very high indeed.

Where do you stand on vaccinating your children, and yourselves?

Sound Off, Odessa!