Tip/Thought of the Day

To Vaccinate Or Not?

For decades, there has been a build up of players on both sides of the fence- to get vaccinated or not?

Because of this, laws were adopted in many states allowing parents the right to “opt out” for their children. According to a recent article in the August 13, 2018 Arizona Daily Star, Arizona law requires that all children attending school or childcare obtain certain vaccines, unless they are exempted by a doctor for medical purposes or by a parent for personal ones. Eighteen states allow parents to exempt their children from getting vaccines based on personal beliefs. A study published in the Journal of the Public Library of Science Medicine in June found that since 2009, non-medical vaccine exemptions, allowing for religious, personal or philosophical beliefs, rose in Arizona and most other states. Even though statewide exemptions rose slightly, Pima County is still doing reasonably well (what does reasonably well gauge?) but there are concerns because the immunity threshold- the percentage of the population needed to contain the spread of certain preventable diseases- is so high. On average, it is 80-95%. That means we have to have a high vaccination rate in order to protect our neighbors, our communities, our families and those who travel or can’t get vaccinated. If the total number of medical and non-medical exemptions rise high enough, it will allow the spread of serious diseases.

A study by researchers from Baylor University in Texas noted that some European countries improved their vaccination coverage by making them mandatory, imposing fines on parents who refuse to vaccinate their children. Europeans were concerned that the rise in non-medical exemptions was linked to the anti-vaccine movement in the U.S. and might encourage other countries to follow suit. This could lead to massive epidemics of infections in children. California recently passed a law in 2016 that mandated vaccines for all children, unless they had a doctor certified medical exemption. They were no longer available to those who pursued them because of personal beliefs. This was prompted by pre-schooler state wide non-medical vaccine exemptions quadrupling between 2000 and 2014.  This also occurred in Arizona, according to U of A researchers, which ultimately caused cases of vaccine preventable diseases to quadruple between 2008 and 2013. Cases of whooping cough increased six fold in that time as well.

Those choosing not to vaccinate have many questions. This prompted The Journal of Family Practice, June 2018 issue to document answers to many of the erroneously publicized concerns in the hopes of helping physicians encourage patients to reconsider their choice.  As flu season approaches I’d like to share these with you:

1)    I’ve heard that vaccines can actually make you sick.

This is not true. Vaccines protect our bodies from foreign invaders such as viruses and bacteria by mounting an immune response when we are exposed to those proteins. Vaccinations work by exploiting this immune response by exposing the body to a killed or weakened viral or bacterial protein load in a safe and controlled manner. In this way, our immune system will have already developed antibodies to virus or bacteria by the time we are exposed to the actual infection. Since the majority of vaccines aren’t live viruses, they cannot cause the illness they are meant to protect us from, they just trigger the immune system. Patients may feel a little under the weather for a day or two, but it will not make them sick. Live attenuated vaccines are similarly safe for those with a healthy immune system. We don’t give them to anyone who has a weakened one such as: pregnant women, newborns, people with immunodeficiency issues, or are on chemotherapy. In these cases, and only these cases, patients could develop the illness we are trying to protect against.

2)    I’ve heard that vaccines cause autism or are toxic to the nervous system.

A 1998 study by Andrew Wakefield suggested that the mercury in the Mumps, Measles and Rubella (MMR) vaccine was linked to the development of autism caused the largest setback to vaccinations in history. This research was subsequently debunked and the author of that study was stripped of all his medical licenses for falsifying data. But, it had already damaged vaccine efforts. The amount of mercury is far below concerning levels. Mercury was removed in 2001 from all US licensed vaccines except for flu shots. Even flu shots contain less than .01%, which is cleared from the body much more rapidly than what we already ingest in certain types of fish, and is less toxic. Ironically since the removal of mercury from vaccines, the CDC noted the rate of autism has actually increased.  Some also worry about the aluminum content which works as an additive to boost the bodies immune response to a vaccine. Aluminum is only used in killed virus vaccinations, not live attenuated ones. We are exposed extensively to aluminum every day in our pots, pans, aluminum foil, seasoning, cereal, baby formula, paint, fuels and anti-perspirant. Vaccinated infants will be exposed to 4.4 mg of aluminum in the first six months of life via vaccines yet will ingest far more. Breast milk contains 7 mg over six months, milk-based formula is 38 mg over six months and soy based formula is 117 mg over six months.

3)   I’m healthy. I never get sick so why vaccinate?

Saying you don’t need a vaccination because you never get sick is like saying you don’t need to wear a seatbelt because you’ve never been in a car accident. It’s to prevent disease. We also seek to vaccinate all members of a community, not just the sick ones, or those at high risk to protect ourselves and create a “herd immunity”. This creates a resistance to the spread of a contagious disease that results if a sufficiently high number of people (typically 80 to 95%) are immunized. When vaccinations fall below this level, we see a rise in vaccine preventable diseases. This was demonstrated in 2017 with the measles outbreak.

4) We don’t see polio anymore so why vaccinate?

It is precisely due to years of vaccination efforts that polio is no longer seen. Smallpox, a deadly, disfiguring disease, killed millions of people and contributed to the downfall of Romania, the Aztec, and Incan empires. It was eradicated from the planet in 1979 thanks to vaccination efforts by the World Health Organization. Vaccinations only work if they are kept up. We may not be seeing these diseases in the United States, but they are still in other parts of the world. Accesible travel options have made our world so much easier to explore and relish. With people able to move throughout the world with relative ease, diseases can be reintroduced anytime if we are not vigilant.

5). I heard vaccines are made from aborted fetal tissue.

Varicella, rubella, hepatitis A, shingles, and rabies vaccines, were originally from aborted fetal tissue. But, it has been 40 years since cells were taken from an aborted fetus. Since that time, the cell lines have grown independently. it is important to note the descendent cells are not the cells of an aborted child. The National Catholic Bioethics Center made the following statement regarding vaccines, acknowledging that “one is morally free to use the vaccine regardless of its historical association with abortion. The reason is that the risk to public health, if one chooses not to vaccinate, outweighs the legitimate concern about the origins of the vaccine. This is especially important for parents, who have a moral obligation to protect the life and health of their children and those around them.”

6)   Vaccines aren’t studied or monitored enough.

Patients and parents should know that vaccines are the most thoroughly studied products brought to the market today. They undergo vigorous testing and oversight from both public and private organizations for 10 to 15 years before being released for distribution. Post-licensing monitoring is ongoing and the CDC and US Food and Drug Administration are constantly monitoring for adverse effects. There is an extensive and effective system of checks and balances in which we can place our trust.

7)  Isn’t it better to get immunized through an active infection?

Researchers found some individuals had the perception vaccine-preventable diseases are not severe. Some believe it’s better to develop immunity through illness rather than vaccination. This can be extremely dangerous since vaccine preventable diseases can be severe, in some cases causing brain damage, paralysis and death. Many childhood diseases may be more benign in children but cause significant morbidity or mortality in adults. Vaccinating with a weakened, inactivated or targeted version of the disease is far safer.

8)  People can get paralyzed or stop breathing after a vaccination,why run the risk?

One of the most feared reactions to vaccination is the Guillain- Barre’ syndrome which does cause paralysis. The CDC estimates the risk associated with the flu vaccine occurs in approximately 1 to 2 cases per 1 million people vaccinated. According to the Mayo clinic only 5-10% affected have delayed and incomplete recovery. In my 30 years of practice, I have only seen 1 patient diagnosed with it and she had complete resolution of her symptoms. Another potential concern is the rate of anaphylaxis following a vaccination. In a 2016 study in the Journal of Allergy and Clinical Immunology the rate of anaphylaxis for all vaccines combined was only 1.31 per 1 million vaccinated. The risk of developing severe complications from an illness is far greater than that of developing a complication from the vaccine itself which is meant to protect us. For example, while the impact of flu varies, it places a substantial burden on the health of people in the United States each year. The CDC estimates that influenza has resulted in between 9.2 million and 35.6 million illnesses, between 140,000 and 710,000 hospitalizations and between 12,000 and 56,000 deaths annually since 2010.

9). I can’t afford vaccines.

The Vaccines for Children Program is federally funded to cover the cost of all vaccines for those younger than 19 years of age who are Medicaid eligible, American Indian, Alaska native, uninsured, or underinsured. There may be a small administrative fee charged by the providers office, but the vaccine is free. Call your local Health Department for other options as well as vaccines for adults.

10). Don’t all of the vaccines recommended for children overwhelm their immune system?

Children are exposed to so many more viral and bacterial proteins on a daily basis by crawling around on the floor, putting their hands in their mouths, and attending school or day care than they are ever exposed to in a series of vaccines. Exposure to proteins in their environment and to those in vaccines only serves to boost immunity and keep them healthier in the long run. Thanks to advances in vaccine production, the 14 recommended vaccines given today contain less than 200 bacterial viral proteins or polysaccharides compared to over 3000 of these immunological components that were in 7 vaccines administered in the 1980s.

11). Why not adhere to Dr. Sears vaccine schedule?

There are multiple ways in which Dr. Robert Sears book, The Vaccine Book: Making the Right Decision for Your Child, published in 2007, misrepresents vaccine science and leads patients astray in making vaccine decisions. Most important, Dr. Sears alternative vaccine schedule requiring the child only receive 2 vaccines per office visit would require a visits to a healthcare provider at 2, 3, 4, 5, 6, 7, 9, 12, 15, 18, and 21 months and then again at 2, 2.5, 3, 3.5, 4, 5 and 6 years of age. This significantly increases the number of office visits, needle sticks and raises the age at which vaccines are given, increasing the risk of outbreaks and decreasing the likehood parents will return to complete the series.

The decision to vaccinate isn’t just a personal choice, but a societal one. We are seeing the consequences in the statistics already discussed. If somebody is sick while riding the bus, in an airplane, at work or school, they expose everyone around them. The people around them then expose others, and this in turn exposes others, and before you know it, that one person was “ground zero” for an epidemic of unvaccinated individuals. Or you have whooping cough, a benign infection in adults, but potentially fatal to a little baby sitting one row behind you. It’s not just about one person’s choice. There are infants, cancer patients, and older individuals who can’t be vaccinated due to a myriad of reasons, all vulnerable to these diseases.

The bottom line is that vaccinations are the easiest and the safest way to prevent disease for ourselves, our families, and those around us. Nothing is perfect, but when we don’t vaccinate, life-threatening or serious diseases can occur. You’re not just putting yourself at risk, you’re putting everyone else at risk as well.

Stay tuned for the next post when I’ll discuss specific vaccines.

    -Dr. Courtney

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