Monday, March 30, 2009

To vaccinate or not to Vaccinate

I read this article in the LA Times yesterday about vaccines and recent outbreaks of Measles in certain communities and it made me mad.  I well realize that parents on both sides of this argument feel very strongly.  So, this could get me in trouble, but I'm willing to take the risk.  The gist of the article is that in California there is a rising number of kindergartners who are getting vaccine exemptions  (essentially the parents saying we don't believe in vaccinating our kid).  They just have to sign a form and the kid can enter school unvaccinated.  This isn't such a problem if the majority of the other kids are vaccinated, but with as few as 5-10% unvaccinated kids you can get mini epidemics of diseases that are otherwise quite rare these days, ie measles, mumps, diptheria etc.  According to the LA times there have been several such measles outbreaks in the San Diego and the rate of unvaccinated kids is especially worrisome in several charter schools and non-catholic private schools.

OK, here is my take on this vaccine thing.  When I was a pediatric resident at the beginning of every year in clinic we reviewed the vaccine schedule, risks and benefits of all the vaccines and why we vaccinate against them.  As you can imagine being me, by the time we were third years my friend and I would joke that the reason to vaccinate against these diseases is because they can KILL.  Most of the diseases vaccinated against are things that kill people.  (OK recently we've added a few not so deadly disease to vaccinate against and I used to use this same argument to question if that was right).  But I digress the main issue at hand seems to largely be the Measles/Mumps/Rubella vaccine (MMR).  This one started to fall out of favor after an article linked it to autism.  The fallacy of that study is that autism typically becomes apparent around 15-18 months and almost every child gets the MMR at 12-15 months.  The two were temporally linked, nothing more.  The only study that really looked at vaccines and autism rates showed no difference.  So, my argument and what I used to advise people to do if they were really worried was just delay the shot until their child was already talking.  OK, so there is the mercury thing, but manufacturers have gotten into that and combined more shots and made more of the vaccines without the mercury contained preservative so that is pretty much a nonissue.  Of course, again, you can delay, space them out and make it even less of an issue if really worried.

So back to the diseases behind the vaccines, why care.  Let's start with measles since that was what the article was about.  Measles still exists in the US and is especially prevalent in certain European countries, not to mention less developed nations.  Measles isn't so bad for the average school age kid, but it is DEADLY for infants, and not good for the elderly or immunocompromised.  I took care of a 9 month old infant who had measles encephalitis as a resident.  The child spent two weeks essentially comatose.  She ultimately went home, but the long term effects are likely significant.  Hello this baby almost died, her parents were rightly infuriated and scared.

 How did she get it?  Her older sibling's friend wasn't vaccinated.  She came home from vacation with measles and before she got sick played at the vaccinated friends house.  Thereby exposing the unprotected child.  The child who was too young to get vaccinated even though her parents would have.  You see there is the problem.  It isn't just one kid.  It effects the community.  The LA times article had several similar vignettes of infants under 1 year of age being exposed to measles by unvaccinated friends of their older siblings.  The year before the measles vaccine was released-  ~500 people died from the measles and ~4500 kids had measles encephalitis.  Do I really need to say more?

OK, so now mumps.  Mumps doesn't seem so bad, right?  It used to be the biggest cause of male infertility.  That's right mumps infections in prepubescent or adolescent boys can leave them infertile.  How about Polio?  Now eradicated from the Western Hemisphere, but its long term effects were devastating.

I could go on, but I think I have said enough.  I guess my bias is obvious.  Please people vaccinate your kids.  If you're really worried, it isn't terrible to slow down the vaccinations, but please.  These are bad diseases.


Amy said...

Thank you! This issue drives me nuts - to me it's a matter of ignorance and/or selfishness, with a good dose of conspiracy-theory idiocy thrown in for good measure. (There, now I will attract the ire!)

We need more and more people like you standing up and talking sense. Good for you!

Anonymous said...

Wow...tell us what you really think!
Seriously though, that was very informative. I don't think that people know what effect these diseases have on people. We know that they are bad, but not specifically why. Thanks for giving all of your friends the 411.

Ellen D. said...

I am glad you said that it is ok to space out the vaccinations. I do wonder how overwhelmed the immune system might be confronted with several serious childhood dxs at one time...even though the vaccine is killed or very weak. And there are lots of illness and disability that seems to be immuno-related. My usually tough daughter has terrible roving muscle pain and weakness every time she gets a vaccine (most recently 2nd Gardasil and I am thinking hard about dose #3) However I can also see the practicality of giving several vaccines at once...while you've got 'em in the office, load 'em up, you never know if they will be back!

JaxMom said...

Send this to the LATimes, Lis.

Eilat said...

Hey -- just lurking about...

I think the vaccines debate should be more nuanced than what is coming out of the MSM. I totally agree with you about the MMR vaccine. In fact, Im surprised the fact that the data for the Wakefield study was *made up* did not get better coverage:

On the other hand, I chose not to vaccinate my son against chickenpox. My concern about this vaccine is that the immunity is not lifelong. They just recently had to add the booster. And who knows when that one runs out? The problem is that losing immunity to chickenpox as an adult is bad news, especially for women of childbearing age, as you know.

Wouldnt it make sense to let kids get chickenpox, thereby guaranteeing lifelong immunity, and scheduling the vaccine at a later age (age 10 or 12, say) if the kid never got it.

I exposed my son to the disease itself and now I know he is immune for life. Mandating the chickenpox vaccine seems to be based more on economics (kids need a week home from school/daycare) than health.

Or am I missing something here?

Lisa said...

I should make something clear. I feel this strongly about the DTaP, MMR, and HIB vaccines. Others you can totally negotiate. UNFortunately, the schools ask for all or none, but yes nuanced positions are better. Eilat on chickenpox- there is some other bad stuff. Hmm maybe there is another post here..?

MsGourmet said...

This debate also rages in Australia. As a mother of two young children I chose to get my children vaccinated. Why- because of the obvious and also because I have an aunt who had polio as a child who to this day wishes she had been vaccinated.

Lisa I think you need to tell us what you think more often!