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Lifesaving
immunizations draw critics
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However, in this age of health-maintenance organizations (HMOs) and the Internet, that blind trust is not so prevalent. Parents now question everything, including things that have been considered sacred like immunizations. Immunizations have been protecting children for decades against potentially deadly diseases like hepatitis B, polio, measles, mumps, rubella, pertussis, diphtheria, tetanus, Haemophilus influenza type b, chickenpox and pneumococcus. Physicians administer some immunizations once and some more than once. The immunizations start at birth, and the majority of the doses are given before a child's second birthday. But not all parents are routinely following those guidelines as they have for decades. Bruce Gellin, MD, executive director of the National Network for Immunization Information, sees this as an issue that doctors need to address. "Why would someone reject [a doctor's] advice? We [doctors] need to better understand that," Gellin said. The National Network for Immunization Information is a partnership among the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, the American Academy of Pediatrics and the American Nurses Association. Its goal is to provide information that helps health care providers communicate with their patients and help parents to know where to look for accurate information. Parents now hear stories from other parents or read them online that link immunizations to diseases like autism and diabetes. In response, some parents avoid all immunizations, and some parents pick and choose among them. "Tell me which disease you would not like to prevent" is Gellin's response to parents who do not think vaccines are necessary. The amount of information can be daunting to parents looking for the truth. "You can't make good decisions with bad information," Gellin said. "It's hard to know where good information is." The numbers point to the success of immunizations. According the U.S. Department of Health, Education and Welfare, immunizations have reduced the number of U.S. children who become infected with diseases for which there is a vaccine available by 95 percent. For example, the average annual number of cases of diphtheria reported in 1920-1922 (three years before the development of a vaccine) was 175,885. In 1998, there was only one case reported. The department estimates that there were 20,000 cases a year of Haemophilus influenzae type b (a leading cause of bacterial meningitis) before a vaccine was licensed in 1985. In 1998 there were 54 cases, a decrease of 99.7 percent. Gellin told the story of a child he knew who had been hospitalized with meningitis caused by Haemophilus influenzae type b, for which the Hib vaccine is routinely administered. The child's mother had two older children whom she had immunized. However, by the time she had the third child, she had started to hear things about vaccines that concerned her, so she decided to wait to immunize. She talked to her pediatrician and looked online but didn't know what information to believe. She chose to wait until the child was 1 year old before deciding whether to immunize, but at 11 1/2 months the child became sick with meningitis as a result of Hib infection. Before the use of the Hib vaccine, 20,000 children in the United States under 5 years old got severe Hib disease annually and nearly 1,000 died. Hib disease can also cause deafness, brain damage and blindness, among other things. The child described by Gellin seems to have escaped those complications, he said, but no one knows what the long-term complications might be. "People like this are becoming victims," Gellin said. The mother didn't know whom to believe, so the child suffered. On the other hand, Alan Challoner's case is an example of frustration with the medical community. His daughter had a bad reaction to the DPT (diphtheria, pertussis and tetanus) vaccine in 1960. The first dose was a full 1cc as usual, but after the girl's initial reaction, the doctor suggested a reduction to a quarter dose for the second injection. However, there were practical difficulties with abstracting .25cc, and so the girl received a .5cc dose, Challoner said. This caused a worse reaction, so she did not receive further DPT vaccines. Usually a child receives five doses total. Challoner now challenges the notion that immunizations are always a good thing. "For those who have a member of their family who has been affected, as I have, I have to say we find it tiresome to continually receive defensive, and sometimes false, information from those whose professional rationale is to achieve a 95 percent uptake of vaccinations for children in their district or nation," Challoner said. "We parents are not blind to the positive aspects of vaccination. We recognize that millions of children worldwide have benefited from the vaccines that have been around for many years. What we find painful is the constant rebutting of the causative issue in order that the 'herd immunity' should not be disrupted." The concerns about immunization are really a case study in doctor-patient communication in the age of mass communication and the Internet, Gellin said. He is convinced that the effectiveness of vaccines tells the most important story. An example is measles. Before the use of a measles vaccine, 6 million people died annually from the disease. Since the development of the vaccine, that number has gone down to 1 million. "Five million kids a year are living because of the vaccine," Gellin said. However, concerns that the vaccine is linked to autism (which have not been supported in scientific studies) have made some parents think twice about giving the vaccine to their children. In the United Kingdom, parents are looking for "measles parties" to take their children to and expose them to measles instead of getting them vaccinated. Gellin said one in 1,000 people with measles has an inflammation of the brain that can cause retardation, deafness, seizures or death. "Who's sticking up for those kids?" Gellin asked. Kathi Williams is a co-founder of the National Vaccine Information Center. The center supports parents' rights to make independent vaccination decisions. Williams said after taking phone calls for 18 years, the stories she hears are the same, but "science has not caught up." She said more pediatricians are becoming more informed about parents' concerns, but the medical community in general is not as responsive. "Parents tell us doctors are more willing to discuss concerns," Williams said. Some calls the center receives are from parents concerned about individual vaccines, and some are from parents already dead set against all vaccines who want to know the laws in their area. Barbara Fisher, also a founder of the center, said another concern of parents is the increasing number of vaccinations recommended. She questions how many diseases are going to need a vaccine and says some diseases are in a different category. For example, she says polio is more serious than hepatitis B. Williams questioned "bombarding" a child's immature immune system with so many immunizations rather than letting the exposure happen naturally. Gellin said we are all constantly exposed to all sorts of things, and the purpose of vaccination is to expose the immune system to something specific. Whether the exposure occurs naturally by breathing it in or having it injected, the immune system will be exposed. Responding to the concern about vaccinations causing an increase in various illnesses, Gellin said the argument seems plausible on the surface but only works if nothing else in society has changed. There have been many other changes in the same time period, from an increase in sugar consumption to an increase in international travel. "Why would you pick that one [new factor] and ignore others?" Gellin asked. Ten years ago, some people thought vaccines were part of the cause of sudden infant death syndrome (SIDS), Gellin said. But the rate of SIDS has been cut almost in half since parents have followed a guideline to put babies to sleep on their backs instead of their stomachs. In that same time period, as SIDS rates dropped, more children are receiving an increasing number of vaccines. People don't ask about link between SIDS and vaccines now, Gellin said; they have moved on to other concerns. "The question is, 'Are they related?'" Gellin said, about linking vaccines with diseases such as autism and diabetes. He said one shouldn't look at a group of diseases together and assume one thing caused them all; each has to be investigated separately. In Part II of the series we will look at what recourse people have when an immunization is found to cause harm. |
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NEWS
AND TRENDS | CAREER
CENTER | EDUCATION
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Washington
(H24N). There was a time when no one questioned
the family pediatrician. Mothers fed their children the foods the
doctor advised when the doctor told them to. Families followed such
advice religiously, and immunizations were considered a miracle.