I am often asked about the advisability and safety of giving immunizations to a child. Many mothers are afraid that the shots could cause autism, mercury poisoning, or serious illness. I know that claims of these consequences have appeared in magazines and other sources of information. As convincing and emotional as they are, these claims are spurious and based on unfounded bad science. The tragic truth is that there are children in our own community suffering and dying from preventable diseases such as Whooping Cough, Measles and Meningitis because of misguided parental decisions not to vaccinate their children.
I give my own grandchildren all of their immunizations on schedule. The newest vaccines, which we now administer to children, are the safest and most effective in medical history. If I feel confident to do this for my own family you should also feel that it is right for your children.
Modern Vaccines are the miracles of our time. Frequent epidemics of Diphtheria swept through every city in the world and left thousands of children dead until the development of the Diphtheria vaccine in the 1940’s. Since that time, one by one, many devastating diseases have been conquered by the development of specific vaccines. These vaccines have enabled people to develop immunity without suffering the actual disease.
There are two different types of diseases for which we immunize children
1) Viruses, such as Influenza, Polio, Smallpox, Chickenpox, Measles Mumps and Rubella, Hepatitis A and Hepatitis B. These are only spread by people. If the whole world’s population is immunized the disease will be eradicated. This has already been achieved with Smallpox, so immunization is no longer needed. There is a possibility that Measles and Polio may be eradicated in the next twenty years. The incidence of Chickenpox has decreased dramatically over the last ten years since the vaccine was approved. The new vaccine against Hepatitis A has been extremely effective. After over 10 years of seeing over 50 cases a year in my practice there have been none since one year after the vaccine was approved. I no longer receive letters from school warning of exposure to Hepatitis requiring Gamma Globulin. This virus is still present in the community where I practice and anyone who has not yet been immunized is susceptible. Israel which has a high incidence of this disease has only just started immunizing children with this vaccine.
Most of these viruses remain the same over time so immunity, once achieved is good for a lifetime. The Flu viruses, unfortunately, change their proteins very often so immunity to one strain is not useful the next year when a new Flu comes along.
2) Bacteria such as Diphteria, Pertussis, Tetanus, Hemophilus Influenza B (HIB), Pneumococcus and Menigococcus. The new vaccine for HIB decreased the number of cases of bacterial meningitis by 90 percent within two years of its incorporation into the regular vaccine schedule. This completely changed my life as a pediatrician since I averaged 6-8 cases of this devastating life threatening infection before the vaccine became available. The new vaccine against Pneumococcus, released just three years ago has decreased the number of young children admitted to the hospital with bacterial pneumonia by 85 percent. These germs, which can live harmlessly in a healthy child’s throat, can become invasive and cause disease. They are not always obviously contagious from one person to another since a contact can pick up the germ and not get sick from it. There is little chance of eradicating these diseases.
Despite the fact that millions of lives have been saved by these miraculous vaccines, there has always been a small incidence of serious side effects. The DPT vaccine often caused fever and, rarely, caused convulsions and a shock like reaction. There was a time in the 1970’s when the health service in England stopped giving the vaccine due to an increase in the number of crib deaths. Within one year there were epidemics of Pertussis causing 30 deaths in small children. During that time when no child was immunized, the incidence of crib deaths did not change at all. The vaccine was reinstituted but there were many cases of Pertussis over the next few years until the health service gave catch up doses to the children who had not been immunized.
In the former Soviet Union where the bankrupt governments have not been able to maintain their vaccine programs there are currently epidemics of Diphtheria and Pertussis.
For fifty years we gave DPT to everyone, knowing that the benefits outweighed the risk. About eight years ago a newer vaccine, DaPT, was approved. This change tamed down the Pertussis component that was the problem. Now the incidence of severe reactions has been reduced to nearly zero. We no longer have to advise the mothers to give Tylenol on the day of the shots to avert high fever.
The Measles Mumps Rubella vaccine, approved in the 1970’s has greatly reduced the number of cases of all of these viruses. Measles is a vicious 10 day illness that has a severe cough, high fevers, and a significant risk of brain damage and death. Mumps, which is characterized by painfully enlarged salivary glands, is milder but can effect fertility in boys and can also cause a serious brain infection. Rubella, also called German Measles, has caused the most devastating problems. Unborn babies, infected through their mothers are often born blind, deaf, and brain damaged. This vaccine has save millions of lives. The children who receive the MMR will sometimes run a fever, occasionally with a flat rash, about 10 days after the injection. Doses are given at age one and five.
About five years ago, an article was published in England claiming a relationship between Autism and the MMR vaccine. Since that time the researchers who were quoted by the author have issued a retraction, claiming that their statistics were not valid for the conclusions that were made.
The doctor who published this article is currently being prosecuted in England for not disclosing that he was being paid by the lawyers representing a group of parents of autistic children. He was paid to produce evidence that would strengthen their lawsuit against vaccine companies. His work was not valid at all.
Several large studies, costing millions of dollars, were conducted in Europe and Asia and the United States trying to find a relationship between the vaccine and the incidence of Autism. There was no evidence to confirm the claim in any of the studies. Meanwhile many parents were so frightened that they stopped immunizing their children. In London and Israel where certain groups are refusing to immunize, there is currently an outbreak of Measles with at least one death in this community.
When you stop and think, you will realize that the risk of not giving this vaccine is far greater than the risk of giving it. Also, anyone who doesn’t immunize is relying on the rest of the population to protect their child. This is really not fair at all. In order to keep these diseases under control we must all accept the tiny risk involved.
The fear that the trace amounts of Mercury in one of the vaccines could cause trouble was based on a mistake. The Mercury that causes damage to the nervous system is a totally different compound than the one used to preserve the vaccine. Despite the fact that there was no evidence that there ever was any damage caused by the Mercury, it was removed from all vaccines and there are no vaccines being produced today with Mercury in them.
The big questions about the Varicella (Chickenpox) vaccine is why is it necessary? The answer is that there is a small but significant incidence of death and there are a large number children admitted to the hospital with serious bone and skin infections complicating Chickenpox. Since the recommendation was issued to give the vaccine to all children the number of children suffering these severe infections has dropped dramatically. The vaccine is only about 85% effective against the chickenpox, but it is 100% effective against severe chickenpox. The children who do get the disease after the vaccine have mild cases.
Is it permanent immunity? In Japan where the vaccine was given for thirty years, the people immunized 30 years ago have the same immunity as the group who had chickenpox at the same time. However, since the incidence of chicken pox is now very low in the United States there is a concern that the natural booster effect from being exposed to chicken pox will be missing. For this reason, a booster dose is now being given at age 4-6.
The incidence of Shingles, (a painful recrudescence of the virus in a region of the skin) seems to be somewhat lower in vaccine recipients.
Polio, a devastating viral infection of the nervous system caused thousands of cases of paralysis every year as the epidemics swept through the cities. OPV, Oral Polio vaccine, which was developed in the 1960’s completely stopped the epidemics. This vaccine had a small incidence of causing the disease itself. There were 3 cases in the U.S. per year from the vaccine. In the year 2000 the decision was made to change to the injectable IPV which has no incidence of complications.
Because of the number of vaccines now being given to each child the current practice is to give multiple shots at one time. This has been clearly shown to be safe. It does not increase the incidence of side effects at all when compared to giving only one shot. The newer vaccines are safer because each one only contains a few antigens. The old DPT contained at least 3000 antigens, many of which caused side effects and did not add to the protection. The refined DaPT, IPV, Pneumococcal Vaccine, Hepatitis B and the HIB, when combined , have only about 25 antigens.
Flu vaccine is now recommended for babies 6-23 months as well as children with chronic illnesses. This is because there are often secondary infections such as ear infections and pneumonia after the flu. There is a nasal spray vaccine, Flumist, that is approved for children over 5 years old. I have always advised my patients to immunize the whole family to prevent Flu. Anyone who has experienced this miserable disease and watched it spread to the entire household knows how important it is to avoid the flu.
There is always some risk in everything we do with our children. We put them on school buses, we cross streets, we drive with them in the car. All of these activities have risks. We don’t think about these risks because we believe that G-d conducts the world. We have one obligation to our children. That is to do the best we can to protect them. If we do our best we know that anything that happens is in the hands of G-d. Immunizing children is the right thing for everybody. We have been blessed in this generation with miraculous medical advances. It is our job and privilege, as parents, to make the most of these gifts and be grateful to the One who made them available to us.