Vaccination: Past and Present

I wrote this following article a few years back for Pittsburgh Parent Magazine. It seems as though the stories are as timely now as they were in
2011. I have not edited or changed anything so if anything is out of date stats-wise, that is the reason. The sentiments and family perspectives are important to consider in the current vaccine debate…

Vaccines—Considering Past and Present

By,

Kathleen Shoop, PhD

Ever since scientists determined that teeny, unseen germs were responsible for disease, people have been clamoring for them to develop safe vaccines to keep those organisms from sickening, crippling, and killing.

The science behind vaccinations is as intricate as Beethoven’s 5th concerto. It’s considered by some a miracle that scientists have been able to engineer immune responses that trigger protective antibodies, but don’t infect the recipient with the offending illness. This complexity, along with fears of rare but severe vaccination reactions, complacency in our relatively immunized population, and an anti-vaccine movement have created an environment in which it may seem to make sense not to vaccinate. In turn, vaccination coverage rates have been dropping.

Dr. Robert Chen, created a graph in 1998 called, “The Natural History of an Immunization Program,” to illustrate that phenomenon. The graph depicts how people respond to the availability of vaccines over time. First, everyone is thrilled to have an answer to deadly, debilitating diseases. After disease is eradicated or rare, a sense of security settles in. People shift their focus from preventing disease to scrutinizing the vaccines and side effects. Next, with the population having forgotten what the diseases are like, portions of people stop immunizing. In the final phase the diseases re-emerge, reminding the general population what it had once fought so hard to eradicate.

To help us understand these forgotten diseases, Wendie Howland, RN, MN, CRRN, CCM, CNLCP recalls “[I remember] classmates’ mothers having blind babies when their kids brought home rubella in [their] first trimesters, babies born dead or deaf from measles, or teenagers who somehow escaped mumps as children only to become permanently sterile when their testes were fried after getting it as adults.”

Mary McManus recalls her experience with polio. “In 1959, at the age of five, I dropped to the ground during kindergarten as we were dancing around the gym. I’d been playing with a good friend the day before and her mother contracted polio the same day as I did. She was unvaccinated and had a much worse case than I had. I was paralyzed on my left side and dependent on my parents for total care during the initial attack of the virus. I was in physical therapy until I was 13. In 1996 I developed the symptoms of post-polio syndrome.”

These stories remind us of what’s at stake when we consider vaccination for our families.

Two Perspectives

The pro-vaccine group is peopled with scientists, doctors, public health practitioners, and growing groups of vocal parents who want to see disease controlled preventively with vaccines.

With another point of view are those who downplay or oppose immunization programs and are part of what is sometimes called the “Anti-Vaccine Movement.” These parents, lawyers and doctors view vaccines as dangerous compared to getting the diseases they prevent. They believe our bodies should be left alone to best fight these illnesses and they view vaccine programs as the result of greedy businesspeople and/or a shortsighted, power-hungry, government machine.

Online searches and books like Vaccine Epidemic: How Corporate Greed, Biased Science, and Coercive Government Threaten our Human Rights, Our Health, and Our Children (edited by Louise Kuo Habakus, M.A. and Mary Holland, J.D.) reveal a plethora of accessible anti-vaccine information, which features powerful parental and medical anecdotes linking vaccines to developmental and chronic illness.

Vaccine Epidemic is framed as a tool for informing the public about parents’ rights to decline vaccinations for their children. Unfortunately, the book largely fails to include scientific data that goes against the premise of the book, and includes many factual errors. One such error is putting forth the notion that diseases such as scarlet fever were eradicated “naturally” over time without a vaccination, and therefore it should be expected that diseases like polio would have done the same.

In fact, scarlet fever is caused by the same bacteria that causes strep throat, and still occurs regularly in the United States. Fortunately, effective treatment with antibiotics has quashed the horrific epidemics of yesteryear. Nonetheless, theories and anecdotes such as these, though not based on sound scientific knowledge, create an aura of truth that gives even the most pro-vaccination parent pause before agreeing to immunize.

Parents in Pennsylvania can refuse to vaccinate their child for medical or philosophical reasons. However, it’s important to know exactly what parents are choosing when opting not to immunize against childhood disease. Sometimes it’s helpful to remember what it was like before vaccines, to revisit what life with once unpreventable diseases was like, as Wendie and Mary’s stories above do. Why? Because some of these diseases are coming back.

According to public health records, hib, pertussis (whooping cough), measles, and mumps outbreaks have been reported in the United States and Pennsylvania in the past several years. Conversations with a variety of parents revealed that there’s a sense that these diseases are no big deal. There is a perspective that when preventable disease strikes it merely inhibits daily life. Mom and Dad need to stay home from work, children are uncomfortable and bored, but that there is no solid reason to prevent these diseases.

If only that were the case.

Paul Offit, MD, (Deadly Choices: How the Anti-vaccine Movement Threatens Us All and person who holds the patent for Rotavirus vaccine) writes that the trouble with letting a few kids here then a few there to go unimmunized is that unprotected individuals grow into groups. He asserts that these diseases are not harmless. Measles, mumps, hib, pertussis–all vaccine-preventable diseases– are smart, efficient and strategic. They know who to attack—the unvaccinated—and as numerous examples in Offit’s book show, they don’t waste time doing so.

The hard facts of preventable disease are striking. Before effective vaccines were utilized parents faced these diseases each year:

Diptheria—12,000 deaths/year—mostly kids

Rubella—20,000 infants born blind, deaf, or mentally disabled

Polio—15,000 children paralyzed, 1000 killed

Mumps—common cause of deafness, sterilization in adolescent males

Hib—20,000 children with meningitis, bloodstream infections, pneumonia, 1000 deaths per year. Many survivors contend with lasting brain damage.

Pertussis (whooping cough)—300,000 cases causing 7,000 yearly deaths

(Plotkin, Orenstein, Offit, 2008, Offit, 2011)

To illustrate the tactical nature of infectious disease, Offit presented the 2005 case of an unvaccinated teenager who returned to Indiana from a trip to Romania. Bearing heart-felt stories and a case of the measles, she spent a few hours at the picnic and in that time infected 31 of 35 (89%) of unvaccinated attendees. Of the 465 vaccinated people at the picnic, 3 (0 .6%) contracted the disease. What does this show? If you’re unvaccinated, you will most likely catch measles when exposed.

This information is powerful, but there are forces against vaccinating in play: complacency, anti-vaccination sentiment, and the fact that there can be rare severe vaccine reactions. The thought of vaccine injury can give the most staunch vaccine advocates second thoughts.

Things can go wrong:

From children being allergic to eggs (in which many vaccines are incubated) and gelatin to shoddy manufacturing practices to imperfect vaccine delivery systems, there can be issues with vaccines.

While University of Pittsburgh’s Jonas Salk’s polio vaccine was one of the greatest developments in public health, the road from Salk’s lab to America’s disease eradication was not completely straight. Soon after the successful vaccine was licensed in 1954, children became infected with polio. One laboratory that produced the vaccine did not fully inactivate the virus and of the 120,000 children who received that vaccine, “seventy thousand suffered mild polio, two hundred were severely and permanently paralyzed, and ten died. It was one of the worst biological disasters in American history,” (Offit, 2011).

In more recent times, John Salamone has testified to the risks of vaccinating. In 1990 Mr. Salamone’s son, David, received Sabin’s oral polio vaccine and contracted the illness. Had David been given Salk’s injection instead, he wouldn’t have been exposed to the live vaccine that was dangerous in combination with his undiagnosed congenital immune deficiency.

 

Salamone’s experience compelled him to advocate for the Salk vaccine, working with the Center for Disease Control not against them. He said, “They were all incredibly professional, all very caring, all wanting to do the right thing,” (Offit, 2011). There can be issues with the development of vaccines, but there are many who see the solution to that as having tight, methodical procedures to ensure vaccine safety, not to avoid them all together. Offit points out in his book that the production of faulty polio vaccine in 1954 “led to the creation of a vaccine regulatory system,” to ensure such events were not repeated.

Vaccine Coverage

Controversy and complacency surrounding vaccinations have caused many parents to decide not to vaccinate their children. Parents wonder, “Why should I take the risk with my child if everyone is already doing it?” Offit offers some thoughts on the matter. “The great unsaid about vaccines is that if everyone in the world is vaccinated it would make more sense for a parent not to vaccinate.” (Offit, 2011). But this only works if enough people are protected. Some children, like those with cancer and other immune system challenges, cannot be vaccinated. They are at high risk for the most virulent effects of these diseases.

Healthy People 2020 suggests 95% vaccine coverage to fend off disease. The Morbidity and Mortality Weekly Report (June 3, 2011) reported that Pennsylvania is at 86.9% coverage for MMR vaccine—the 2nd lowest in the country. There have been measles, hib, mumps and pertussis outbreaks in Pennsylvania recently, as might be expected due to the relatively low vaccine coverage rates.

A Different Focus

The March of Dimes along with the Sounds of Pertussis (whooping cough) Campaign are targeting adults for vaccine coverage. Pertussis is a good example of a disease that adults can help fight off for the unvaccinated. Pennsylvania is right at 90% coverage for pertussis vaccines in children, but pertussis provides a unique window into what happens when there isn’t quite enough protection.

It turns out that adults need to have a pertussis booster in order to remain immunized against the disease. When adults contract pertussis, they might present with mild symptoms, but they can easily pass it to unimmunized babies for whom it can be deadly.

Unprotected

Rodney and Jerri-Lynn Throgmorton wanted nothing more than to protect their daughter when she came into the world, unexpectedly at home. Rodney recalls the moment he delivered Haleigh, “Words can not express my bond.”

“Once at the hospital, my mom decided to sleep in the waiting room because she had been coughing pretty hard and did not want to keep us awake.  Later we realized she already had pertussis.” The disease then spread to Rodney and his father, and two weeks later, to newborn Haleigh.

“We were frightened when repeated trips to the doctor did not produce any benefit. [When Haleigh was]  moved to the pediatric ICU, we were scared out of our minds.”

After Haleigh was diagnosed with pertussis, Rodney says, “… I read that there was a 2% chance of death [and] I was mortified because that seemed like incredibly bad odds.  I would take that chance myself and see it as 98% chance of living, but this was my baby girl, who I literally brought into this world.”

Haleigh died when she was 42 days old.

“I was still coughing to the point of throwing up a full six months after being sick.  It was an almost constant reminder of what had taken the life of our baby girl.”

Rodney is compassionate about vaccination. “I would never presume to tell other people how to raise their kids.  I understand people’s fear of the unknown and that leading to them choosing not to vaccinate their kids.” However, Rodney points out that a family can protect their babies by getting their own booster shots.  “We would have all done that had we known. I can think of nothing worse than being responsible for the death of your own child. I think one reason I share Haleigh’s story is atonement. I think a parent choosing not to vaccinate themselves is akin to that parent leaving a loaded gun lying around.”

Natalie Norton is a mother who speaks for the Sounds of Pertussis campaign. Her son, Gavin, died of whooping cough in 2010. She recalls, “Richie and I were so excited to have another son. In 2009 we flew to Utah from Hawaii for Christmas. Gavin was two months old.” At the time, Gavin was healthy and was due to have his pertussis vaccination after the trip. “Around December 26, 2009 Gavin developed a small cough; and by the 29th he was gasping for air, turning blue and there was no way to relieve it.”

The Nortons made repeated trips to the doctors. “After several appointments and time in the hospital they determined Gavin had pertussis, sedated him and suctioned his lungs. He screamed and cried until he couldn’t breathe, his body shut down, and his organs began to fail.”

The pertussis progressed quickly. “I don’t think I realized how dire it was until a few hours before he died. I knew we had to let him go. I held him and told him I loved him and that I was sorry I didn’t know I could have protected him.”

Natalie is using her experience to warn other parents of the dangers of them not being vaccinated. “When babies Gavin’s age contract pertussis there’s very little they can do. Prevention is the key. No one mentioned I needed a booster. I would have gotten one if I had known.”

Siobhan Dolan, MD, a consultant to the March of Dimes said the Sounds of Pertussis campaign focuses on adult vaccination as well. “Adults who will be around newborns need a booster if they didn’t receive one after the age of 12. Women who are thinking of becoming pregnant should get the booster beforehand and those who did not should get it before they leave the hospital post-partum.”

As both Rodney’s and Natalie’s stories demonstrate, “cocooning” small children in pertussis-free environments is imperative.

Conclusion

Pro and anti-vaccine advocates, share the same passion, the same sorrow, the same worry, and the same goal—to keep our children safe.

The debate isn’t whether parents should be forced to vaccinate—in Pennsylvania, they’re not. Looking at the evidence and deciding how to best protect children is the key to finding your answer to the questions raised in the pro/anti-vaccine argument.

Vaccines are not perfect. There are advocacy roles for parents in pushing for vaccine safety that don’t shove the use of vaccines completely off the table. There is work to be done. But, as Natalie Norton and John Salamone show, the work can be cooperative.

http://www.soundsofpertussis.com

http://www.marchofdimes.com/search.html