Vaccines?

By Jeremy Aguinaldo
February 16, 2016

vaccinesMost Americans have not been affected by whooping cough, measles, mumps, or rubella. These diseases are mostly forgotten. There was a time in the 19th and early 20th centuries when these diseases killed thousands, predominantly young children. The lower rates of these illnesses in the middle of the 20th century can be attributed to improved sanitation, better-quality living situations, strict regulations in food preparation, significant advances in medical science, and vaccines. Vaccines in particular showed a dramatic drop in disease rates after their introduction [1].

Today, our society will hardly notice these illnesses unless a direct threat is detected. Compared to a time when these pathogens killed daily, the American public has now viewed vaccines as a form of entitlement. Whooping cough, diphtheria, and the others are now considered to be minor troubles that one could easily survive.

I understand that vaccinations is a hot-button issue that everyone seems to have a strong opinion on. I implore those to do their own research to help answer their questions and concerns. Unfortunately, the internet is filled with stories that show misinformation or disinformation. Consequently, this lead to conspiracy theories that have caused unfortunate outbreaks that could have been easily prevented.

In 1988, a worldwide campaign was started to eradicate polio, an infectious disease that usually leads to paralysis. The plan was almost successful until 2003. A conspiracy theory from the Muslim population of Nigeria believed that the vaccines were made to sterilize Muslims. Due to this belief, sixteen countries where polio had previously been eradicated had reported outbreaks of the disease [2].

In 2015, a large outbreak of measles occurred in California that began in Disneyland. This has led to 173 people to become infected in 21 states. Studies were shown that inadequate vaccine coverage played a key role in the outbreak and that the immunization rates were far below that is necessary to keep the measles virus at bay [3].

The purpose of writing this article is to focus on questions. Particular on the most commonly asked questions regarding vaccines. I feel that some health professionals do not realize how important it is to properly communicate on the importance of vaccines and address the concerns regarding it. I had noticed few health care workers that would belittle those who choose not to vaccinate. Patients who do not adhere to the vaccination schedule for their children would be accused of being a terrible parent. If they were considering not getting vaccinated, insulting them outright would not help them change their mind. Explanations to the public are usually lost on complicated medical jargon.

There are valid contraindications for children not to be vaccinated. These reasons include their medical history, allergic reactions, or troubling previous experiences with vaccines. Most parents usually give their own reasons due to their bad experience themselves, troubling information they had obtained from other sources, or conflicting religious/personal belief.

“Why so early?”

Sample questions: “How is the scheduling for vaccinations decided?” or “Why do certain vaccines have those specific times?” or “Who decides on the scheduling?”

The scheduling of vaccinations are determined based on the epidemiology of the particular disease, how it is spread, and at which point in a person’s life is at most risk for serious harm. The timing on when to vaccinate is decided by the committee involving the Advisory Committee on Immunizations Practice, Center of Disease Control and Prevention, Committee on Infectious Diseases, and American Academy of Pediatrics. It is important to check the updated schedule to stay up to date with the current recommendations. The use of vaccines is strongly reviewed by a committee comprising of experts in Epidemiology, Statistics, Microbiology, and Pathology [4].

Often, these diseases are severe in younger children. By starting early, it will ensure that the youngest and often most fragile are protected as soon as possible.

Prior to vaccines, most deaths due to Pertussis occurred in infants younger than 6 months of age. The peak incidence of meningitis due to Haemophilus infuenzae type B was approximately 9 months before the introduction of the conjugate vaccine [1].

Immunologically, the levels of maternal antibodies which helps in protecting the infant that was initially present at birth begins to decrease with each month of age, with minimal protection by the sixth month. The vaccines for Measles-Mumps-and Rubella (MMR) and Varicella (Chicken Pox) are given at 12 months when all maternal antibody is gone so that these live vaccines are not inactivated by the residual maternal antibodies [1].

Infant’s antibodies with the initial rise and fall of Maternal IgG by after birth, followed by the eventual rise of the infants own antibodies.

Infant’s antibodies with the initial rise and fall of Maternal IgG by after birth, followed by the eventual rise of the infants own antibodies.

“Will too many vaccines overwhelm my child’s immune system?”

Doses of Vaccines comparison between 1983 vs 2015.

Doses of Vaccines comparison between 1983 vs 2015.

Sample questions: “Can I overload my child’s immune system?” or “Don’t you think there is too many too soon?” or “I thought you said the youngest is often most fragile?”

I came across a table that compared the number of vaccines from 1983 to today and it showed an obvious drastic increase. In addition, “scary” names had also been added to the list such as: Rotavirus, Influenza, Varicella, and Hepatitis A and B.

E.coli covered in multiple immunological components.

E.coli covered in multiple immunological components.

Despite the additional number of vaccines given, it is hardly at a level of concern. Compared to the exposure and immunological challenges that infants handle every day, the challenge from vaccine components are minute. These exposures are constant: from the food that we eat, dust that we breath, to the water that we drink. Infants are colonized with trillions of bacteria with each bacterium containing about 2,000 to 6,000 immunological components in addition with multiple viruses. In total, vaccines contain about 150 immunological components [5].

The idea that vaccines will overwhelm a child’s immune system is like arguing that a tablespoon will make an Olympic swimming pool overflow.

 

“What about spacing out vaccines?”

Sample questions: “I do believe in the importance of vaccines, I just don’t like the idea of getting so many at one time. Can I simply space it out?”

This would seem like a logical idea since it would help alleviate parent’s concerns and beliefs about overwhelming a child’s immune system. The committee who designates the schedule studied the risk of infection to the infant, the severity of the illness, and understand the whole problem in terms of public health.

The basic reasoning on why vaccination schedules are set the way they are is that delaying vaccines increases the time children will be susceptible to serious illnesses.

In 2014, 32,971 cases of Pertussis were reported to CDC representing a 15% increase compared 28,639 cases reported during 2013.On July 2, 2015, the Washington State Health Department confirmed the first measles-related death since 2003. These cases are examples of the risk for those who are unvaccinated or delayed [6].

Spacing out the vaccination schedule would lead to additional visits to the doctor. A study was shown that measuring secretions of cortisol (a stress hormone), researchers have found that children experienced similar amounts of stress, whether they are getting one or two shots at the same visit. This study suggest that even though children are clearly stressed by receiving a shot, two shots are not more stressful than one. More visits to the doctor created by separating or spacing out vaccine will actually increase the trauma of getting shots [7].

In terms of safety, studies have shown no evidence that supports that spreading out the schedule decreases the risk of adverse reaction.

Dr. Sears alternative vaccine schedule.

Dr. Sears alternative vaccine schedule.

“Isn’t natural infection better than vaccination?”

Bordatella pertussis and child with whooping cough.

Bordatella pertussis and child with whooping cough.

Sample questions: “Can I simply exposed my child to another sick kid rather than go through vaccines?” or “Can I simply take my child to one of those Pox parties?”

It is true that natural infection induces a stronger and longer lasting immunity than vaccines. The proteins found in these microorganisms allow the immune system to better identify them for future protection. The more proteins on these pathogens, the better they are to be recognized. Unfortunately, some of those proteins can lead to the release of certain toxins that can occasionally be severe and even fatal.

Pseudomembrane and Corynebacterium diphtheriae.

Pseudomembrane and Corynebacterium diphtheriae.

The Pertussis Toxin is involved in the colonization of the bacteria on the respiratory tract which leads to Whooping Cough [1].

The Diphtheria toxin enters cells and inhibits protein synthesis, which facilitates the formation of a pseudomembrane covering the posterior portion of the pharynx and can extend to the tracheobronchial tree [1].

It is simply a risk not worth taking.

“I got the disease after I received the vaccine for it! What happened?”

Sample statements: “I don’t want that vaccine, I always get sick.” or “I’ve had bad luck with vaccines in the past, I don’t want my child to go through it like I did.” or “Vaccines never work.”

This is the concern that is most often brought up by most regarding their feelings for vaccines. When I usually discuss vaccines to a group, I always have that one person who proclaims, “I never got a vaccine before and I have never been sick.” Sometimes, another person would say, “I was vaccinated several times, and each time I became severely ill.”

There is an expectation that getting vaccinated will prevent any form of sickness. Unfortunately, the reality is that not everyone will generate a protective immune response. Every person is different, and multiple factors are involved such as age, ethnicity, gender, socioeconomic status, etc. Even luck can sometimes play a role since one vaccinated person could show immune response on a particular day but may not on a different day. It is unclear on why this happens due to so many forces at work, therefore it would be hard to predict if a person will be immune or not.

Vaccines are not 100% effective. Most childhood vaccine are successful when administered properly and all doses are received. Even though vaccines have their limitations, maintaining a high level of community immunity have shown proper protections against diseases and is important as a public health service [8].

I understand that this concept is difficult to explain to those who are negatively affected by it, whether they have no immunity from the vaccine or suffered from rare side effects. When the chance of a negative outcome is less than 1%, and you are unfortunately that 1% who got affected, understanding the probability of the risk would not matter much.

It is easy to view vaccinations as a public health issue and how it plays a role in protecting the population, but I also understand how being the few individuals who do get sick may not appreciate the overall benefit.

So when I hear other people talk about their negative experiences with vaccines, Empirical evidence (information gathered in a controlled study) usually has more weight than Anecdotal experience (a personal experience by only that person and is entirely subjective).

“Does Big Pharma make a huge profit from pushing vaccines?”

Sample questions: “Is Big Pharma involved in a huge cover-up regarding vaccines?” or “Is Big Pharma purposely making us sick with vaccines, so they can get more money from the people?”

In the past five years, the United States has faced shortages of several childhood vaccines. There are multiple reasons for these shortages, including companies withdrawing from the vaccine market.

Once a vaccine is manufactured, the pharmaceutical company hardly gets any benefits from its effort since vaccines are significantly less profitable than other drugs. GlaxoSmithKline, the largest vaccine manufacturer in the world had $4.3 billion of vaccine sales. In comparison to Lipitor, a cholesterol-lowering medication, earns $6 billion a year. In terms of global pharmaceutical sales, vaccines only comprise of 1-2% [9].

A study has shown variable costs of vaccine administration exceeded reimbursement from some insurers and health plans [10].

“Why do we vaccinate newborns against Hepatitis B?”

Hepatitis B virus and Hepatocellular Carcinoma.

Hepatitis B virus and Hepatocellular Carcinoma.

Hepatitis B is the most common liver disease in the world. Babies can be infected during delivery from infected-mother. Infants infected with Hepatitis B have a 90% chance of the disease becoming chronic. According to the World Health Organization (WHO), “The main objective of hepatitis B immunization strategies is to prevent chronic hepatitis B virus (HBV) infection and its serious consequences, including liver cirrhosis and hepatocellular cancer.” [11]

Routine vaccination was recommended for some U.S. adults and children in 1982. The recommendation expanded to cover all children by 1991.

HBV infection is estimated that over 2 billion of the global population have been infected. 360 million of those are chronically infected and at a risk of serious illness and death. It is estimated that there are 500,000 to 700,000 deaths per year around the world.

“Are the Ingredients in Vaccines Dangerous?”

Sample questions: What is the deal with all those scary chemical names?” or “Why are we injecting these poisons into our children?”

Research has shown that humans have a broad tendency to favor the familiar over the unfamiliar. In April 2013, radio station in Lee County, Florida told listeners that dihydrogen monoxide (DHMO) was coming out of their water taps as an April Fools Day joke [12]. The result was several calls by concerned consumers to the local utility company, which sent out a release stating that the water was safe. There had been incidences of concerned citizens who demanded that Dihydrogen monoxide (water) to be regulated, labeled as hazardous, or banned. This type of paranoia illustrates the lack of scientific literacy and an exaggerated analysis can lead to misplaced fears.

dihydrogen monoxideThe most common components in vaccines that are continuously questioned include: ethylmercury, aluminum, and formaldehyde.

Mercury comes in thimerosal as ethylmercury and is used as a preservative. The fear of this component comes from the confusion with methylmercury, which is the form that damages the nervous system and bioaccumulates in the body, particularly in fishes. Since 2001, thimerosal has not been used as a preservative in routine childhood vaccines (except in some Flu vaccines) [13].

Aluminum is used as an adjuvant. An adjuvants plays a role to improve the immune response of the vaccine. It does this by triggering dendritic cells into action via inflammation. The cells carries the antigens to where it can systemically induce an immune response. Aluminum is the most common metal in nature; and can be found in the food and water. By comparison, infants get more aluminum through ingesting breast milk or formula than vaccines [14].

Formaldehyde is used in tiny amounts to detoxify diphtheria and tetanus toxins as well as to inactivate viruses. Humans have formaldehyde normally in the blood stream. Compared to vaccines, blood has a much higher levels of formaldehyde at approximately 0.1 millimolar. In the human body, it is formed in the metabolism of endogenous amino acids [15].

Paracelsus, born in 1493 in Switzerland, is considered the founder of Toxicology. He was credited to the adage, “The dose makes the poison.” Anything can be lethal if given the right amount. That was why there is strict regulations and set limitations on certain chemicals found in everything such as food, medicine, as well as our water. Even the infamous dihydrogen monoxide can be fatal if given at a large fatal dose.

“Autism?”

Sample questions: “Will my child get autism from vaccines?” or “Is the rise of autism due to the increase use of vaccines?”

I contemplated whether I should address this issue. After a decade of multiple studies and research, there is no evidence that the MMR vaccine is associated with autism. Yet, it is still a question commonly asked.

In February 1998, Andrew Wakefield published a paper in The Lancet that described the cases of eight children who developed autistic-like symptoms, as recalled by their parents shortly after getting their first MMR dose [16]. The paper suggested a possible link to the MMR vaccine and a possible gastrointestinal role which he would he later referred to as autistic enterocolitis. In 2010, the study was retracted after Dr. Wakefield was found to have falsified his research. Despite the withdrawal of the study’s findings, it is still a constant issue propagated by the anti-vaccination movement.

In 2015, a study of about 100,000 children had the largest sample size thus far to determine whether there is a link between the MMR vaccines and autism [17]. The study found in the Journal of the American Medical Association have shown that even those with an increased risk of autism (such as having an older sibling who had the disease) the risk of being diagnosed with the disorder if they were given the MMR vaccine would be the same as compared to those who were not vaccinated. The study confirmed that there was no connection between the two.

Conclusions

I feel it is important for health professionals to be effective and empathetic in communicating to parents who are considering not vaccinating their children. They should feel comfortable voicing their concerns or questions and to ask them to identify the source(s) of those concerns or beliefs. Clinicians should listen carefully, explain misunderstanding or reasons for administering vaccine and provide correct information about the safety issues associated with it.

 

References:

  1. Hamborsky, J., Kroger, A., & Wolfe, C. (Eds.). (2015). Epidemiology and Prevention of Vaccine-Preventable Diseases (5th ed.). Atlanta: Center for Disease Control and Prevention. Retrieved from http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/table-of-contents.pdf
  2. Warraich, H. J. (2009, June). Religious Opposition to Polio Vaccination. Emerging Infectious Diseases, 15(6), 978. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2727330/pdf/09-0087_finalL.pdf
  3. Zipprich, J., Winter, K., Hacker, J., Xia, D., Watt, J., & Harriman, K. (2015, February 20). Measles Outbreak — California, December 2014–February 2015. Morbidity and Mortality Weekly Report (MMWR), 64(6), 153-154.
  4. The Advisory Committee on Immunization Practices (ACIP). (2013, February). Retrieved from Center for Disease Control and Prevention: http://www.cdc.gov/vaccines/hcp/conversations/downloads/vacsafe-acip-color-office.pdf
  5. Offit, P., Quarles, J., Gerber, M., Hackett, C., Marcuse, E., Kollman, T., . . . Landry, S. (2002, January). Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System? Pediatrics, 109(1), 124-129. Retrieved from http://pediatrics.aappublications.org/content/pediatrics/109/1/124.full.pdf
  6. Moyer, D. (2015). Measles led to death of Clallam Co. woman; first in US in a dozen years. Washing State Department of Health.
  7. Fisher, M. C., & Bocchini, J. A. (2009). Adhering to vaccine schedule is best way to protect children from disease. American Academy of Pediatrics, 30(1).
  8. Services, U. D. (2008). Understanding Vaccines: What they are and how they work. NIH Publication.
  9. Iglehart, J. K. (2005). Financing vaccines: in search of solutions that work. Heatlh Affairs. Retrieved from http://content.healthaffairs.org/content/24/3/594.full.pdf+html
  10. Glazner, J., Beaty, B., & Berman, S. (2009). Cost of Vaccine Administration Among Pediatric Practices. Pediatrics, 124(5).
  11. Prevention, C. f. (1991). Hepatitis B virus: A comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination: recommendations of the immunization practices advisory committee (ACIP). Morbidity and Mortality Weekly Report, 40, 1-19.
  12. (2013). 2 radio personalities suspended due to April Fools’ Day prank. Florida: wftv9. Retrieved from http://www.wftv.com/news/news/local/2-radio-personalities-suspended-due-april-fools-da/nW9gM/
  13. (2013). Understanding Thimerosal, Mercury, and Vaccine Safety. Center for Disease Control and Prevention. Retrieved from http://www.cdc.gov/vaccines/hcp/patient-ed/conversations/downloads/vacsafe-thimerosal-bw-office.pdf
  14. http://www.cdc.gov/vaccinesafety/Concerns/adjuvants.html. (2015, April 15). Retrieved from Center for Disease Control and Prevention: http://www.cdc.gov/vaccinesafety/Concerns/adjuvants.html
  15. Common Ingredients in U.S. Licensed Vaccines. (2014, May 1). Retrieved from U.S. Food and Drug Administration: http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/ucm187810.htm
  16. Wakefield, A. J., Murch, S. H., Anthony, A., Linnell, J., Casson, D. M., Malik, M., . . . Walker-Smith, J. A. (1998, February 28). Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet, 351(9103), 637-641.
  17. Jain, A., Marshall, J., Buikema, A., Bancroft, T., Kelly, J., & Newschaffer, C. (2015). Autism Occurrence by MMR Vaccine Status Among US Children With Older Siblings With and Without Autism. The Journal of the American Medical Association, 313(15), 1534-1540. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=2275444
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