Vaccine Myths – Playing with Fire

This week is national immunization week, according to the Institute of Medicine and the American Academy of Pediatrics, an opportunity to revisit and refresh on many of the vaccination myths that persist in our community.

In recent years we have seen a resurgence of pertussis cases across the United States. Pertussis, also known as whooping cough, causes a lengthy coughing illness in adolescents and adults and can be life threatening to  young children.  This increased incidence is thought to be related to decreasing immunity over time associated with the newer “acellular” vaccine, the cyclical nature of pertussis, possible genetic changes in recent circulating strains, and decreased “herd immunity” caused by lower rates of vaccination.

Herd immunity occurs when a high percentage of a population is vaccinated.  A high level of vaccination within a community will decrease the likelihood of a disease outbreak and provide some protection against illness to both vaccinated and non vaccinated persons. If the immunization rate dips below “herd immunity” level the community will be at risk of disease outbreaks. Prior to introduction of the pertussis vaccine, the United States saw more than of 200,000 cases of pertussis every year.  By the late 1990’s we were seeing less than 10,000 cases reported nationwide. This number crept up to 25,000 cases in 2004, and more pertussis cases were documented in 2010 than in any year since 1947!

Last  October, Pediatrics published an article looking at non-medical (religious or philosophical) vaccine exemptions and clusters of pertussis outbreaks.  The study evaluated rates of pertussis in schoolchildren in California from 2005-2010. The rate of non-medical vaccination exemption tripled from 0.77% in 2000 to 2.33% in 2010. Importantly, parents who chose not to vaccinate their children often lived in close proximity to other like-minded parents and some communities had exemption rates as high as 84%.  People who lived within one of these exemption clusters were 2.5 times more likely to also be in a pertussis cluster.  In other words, people living in areas with high rates of non-vaccination were more likely to be affected by pertussis outbreaks.

Common Vaccine Myths

1) Choosing not to vaccinate my child does not affect anyone else – False.  As the number of persons choosing not to Child About To Get An Injectionvaccinate increases, the overall herd immunity of a community declines, placing the community at risk for an outbreak.  Also, some people are not able to be vaccinated due to different health concerns (too young to receive certain vaccines, many children undergoing cancer treatments, and children with some immune problems).  These children are all especially vulnerable to developing severe illness if they contract a vaccine-preventable illness and rely on herd immunity to be safe from illness.

2) My child is vaccinated so they are not at risk – False. No vaccine is 100% effective at preventing disease in all persons.   The acelluar pertussis vaccine is known to have decreasing immunity and even vaccinated persons are at risk of acquiring the illness after several years.  For easily spread infections such as pertussis and measles a herd immunity rate of at least 95% is necessary to prevent outbreaks and to keep the entire community safe.  A very small number of vaccinated children will have poor immune response and won’t develop lasting immunity.  These children also need to rely on herd immunity to stay safe from illness.

3) Vaccines cause autism – False. Numerous studies have been done looking for an association between autism and vaccines.  No correlation has been found.

4) Vaccines contain mercury- False. Thimerosal, a type of mercury, used to be a common preservative used in vaccines. With the exception of some multi-vial flu vaccines, it has been removed from all pediatric vaccines. Most pediatric clinics carry thimerosal- free flu vaccines as well.

5) Babies are getting too many shots too early – False.  Vaccines are given early in life for a reason. Young children and babies are at especially high risk for complications from many of these illnesses. In 2008 there was a Haemophilus influenza (Hib) meningitis outbreak in Minnesota. Five children contracted the disease.  One of these children died. Three were unvaccinated, one was too young to have completed the primary series, and one child had an immune deficiency.    Some parents ask me about alternative vaccine schedules. This decision should not be taken lightly and should be discussed in conjunction with your pediatrician.  The current vaccine schedule was designed to keep your child and our society as a whole healthy. The Institute of Medicine (IOM) recently did an in depth investigation into the current vaccine schedule. They found no safety concerns associated with the current vaccine schedule. They did, however, find increased risk of illness and outbreaks associated with delayed or modified vaccine schedules.  The American Academy of Pediatrics, Institute of Medicine, and Centers for Disease Control (CDC) all advise that children be vaccinated on schedule.

6) Children’s immune systems can’t handle vaccines.  – False.  Children’s immune systems are designed to handle new antigen (components of vaccines and diseases) exposure. In fact, they encounter more antigens simply though every day play and exposure than from the entire primary vaccine series.   Due to improvements in vaccine manufacturing, the primary vaccine series today contains fewer antigens than single vaccines used 50 years ago.

7) Natural immunity is better – False. As a pediatrician I have seen numerous cases of vaccine-preventable illness.  I have seen babies hooked up to breathing tubes, children die, and countless unnecessary hospitalizations and complications from illnesses that could have been prevented by following the recommended vaccine schedule.  I am proud to say that my 2 year old child is fully vaccinated.

 

 

Sarah Lenhardt, MD About Sarah Lenhardt, MD

Sarah J. Lenhardt is an Instructor in Pediatrics at Washington University School of Medicine. She cares for children at St. Louis Children’s Hospital, Missouri Baptist Medical Center, and at Progress West Healthcare. She attended the College of Saint Benedict in St. Joseph, MN and Creighton University in Omaha, Nebraska. Dr. Lenhardt completed a residency in Pediatrics at the University of Minnesota and worked as a general pediatrician in Minnesota before joining the faculty at Washington University. She is a board Certified pediatrician and a member of the American Academy of Pediatrics. Her special interests include preventative care, integrative medicine, and breastfeeding. Dr. Lenhardt enjoys spending her free time with her husband and 1 year old son.

Comments

  1. I have a biology degree and agree with most points about vaccination. However, in the interest of new information, I’ve recently read up about the anti-vaccine viewpoint. It seems that a very convincing argument for a lot of people is people saying that they know a doctor who chooses not to vaccinate their children, or who chooses to not use the combination vaccines or flu vaccines. This seems unverifiable, as they would state the doctor is REQUIRED by their profession to push vaccines. Am wondering do you happen to know the percentage of your colleagues or those generally in the profession that truly have this viewpoint? Do you think there any way to verify these sort of claims?

    I personally do not find such unverifiable arguments in general trustworthy, but it is obviously quite effective, thus troubling.

  2. Dear Grace,

    Physicians are not required by any organization or entity to push vaccines. There is a debate in the medical community about how to handle families who choose not to vaccinate, or to vaccinate partially or on a delayed schedule. Some pediatricians actually tell these families that they need to find a new physician. Most physicians will give families their best information on vaccines and then respect a parent’s autonomy to choose how and if they vaccinate their children. The American Academy of Pediatrics actually recommends that physicians keep non-vaccinating families, rather than recommending that they find a new physician.

    Sadly, there are some physicians, often non-MD physicians, who actually recommend alternate vaccination schedules or even non-vaccination. I am sorry, but I don’t have any good data about the percentage of licensed pediatricians who hold this view. I suspect it is very small. Most who hold these views are naturopathic or homeopathic physicians or other non-MD health practitioners. There is some weak data from Swiss pediatricians that suggests the number is about 5%, but most of these are physicians recommending homeopathic management. I do not know if these where licensed physicians in the country of Switzerland, or if this included unlicensed health practitioners.

    Thanks for your comment!

  3. In our practice, we try to be as understanding as possible when it comes to the parents’ vaccination beliefs. However, we also believe that an unvaccinated child places the rest of our practice at an increased risk for certain diseases. We will try to honor a family’s wish for alternate vaccination schedules, but parents who outright refuse all vaccinations will likely be asked to seek another provider.

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