An Abridged Version of a Good Analysis of the Immunization Issues

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An Abridged Version of a Good Analysis of the Immunization Issues

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These are easy to read and understand and are beautifully presented.

1. My understanding is that in the U.S. the advent of death from adverse reactions to vaccinations is equal to the advent of death due to the diseases which vaccines are created to avert.

This is not true, and even the most anti-vaccine activists would not agree with this statement. I have done extensive research into vaccinations, reading all the "crap" on both sides. I agree that most of the information available is unreliable; the anti-vaccine people mostly grabbing at fantastic theories and using spurious research to back up their claims; the mainstream authors denying there is any risk to vaccinating.

The calculus goes like this: as more and more of the population is immunized a concept called "herd immunity" takes hold. Although the immunization does not fully take in every person receiving it, and artificially acquired immunity wanes with time, if a threshold of immune people exists in a population there are not enough sensitive people to sustain the organism and allow for an outbreak. We have seen the reverse of this in recent years on college campuses, as large numbers of "properly" vaccinated young people live in close contact just as their acquired immunity to measles is waning. The proportion of immune people drops below the magic number (which is disease specific) and Voila! an outbreak of disease in a largely previously vaccinated population.

Because you don't need 100% immunity in a population to prevent outbreaks of the disease, the "failures" of vaccines are acceptable. Some people will never convert to immune (by titers) no matter how often you give them the immunization. Most artificially acquired immunity will wane over time (10-20 years), but by that time the age-specific susceptibility is usually past, and the person is no longer a good "carrier" for the disease. Ok, so you only need, say 60% of the population truly immune to keep the disease in check. No more outbreaks, isolated cases occur from the natural disease (vaccine failures). Parents who choose not to immunize are protected by this herd immunity (essentially securing their child's health at the expense of the compliant parent's kids who risk vaccine reactions).

Only when the background rate of the natural disease approaches zero, does the adverse affect of the vaccine start to rear it's ugly head. Seems kinda insane to risk death or paralysis from a live (attenuated) polio vaccine when there hasn't been a "natural" case in this country in more than 15 years.

What she said is true only for polio, and only for the oral polio vaccine, which is a live attenuated vaccine, and causes about 10 cases of polio a year, mostly in unvaccinated playmates or siblings of recently vaccinated children, or in immune compromised adults who come in contact with recently vaccinated children. The switch to the injectable "dead" vaccine is a most sensible response to the situation. Or a parent can simply ride the herd immunity and assume their child will never be exposed (as long as their playmates are not given the oral live vaccine).

The whole debate about vaccinations is very complex and quite interesting. There are vaccine opponents who sift through the epidemiologic data to "prove" that the diseases would have waned in the population without vaccinations, and argue that immunizations are unnecessary. Others seize on the stubbornness of mainstream medicine's refusal to acknowledge adverse reactions to vaccines as proof of a conspiracy. Others make gigantic assumptions about the possible role of routine childhood vaccinations in promoting asthma, cancer, diabetes; compelling ideas, but offer no reliable information to evaluate their claims.

I come down in a compromise position; given the state of current research it is probably unnecessary to give your child 15 separate immunizations in the first year of life. When we have more information about the benefits of timing of immunizations, we may be able to make better choices. Infants do not need protection from Hepatitis (unless they are likely to be exposed through environmental or familial contact, such as travel to asia) until they are at an age where they could contact the disease through recreational (sex and drugs) or occupational (healthcare) exposure.

Similarly, a child who is not independently mobile hardly needs protection from tetanus, because they will not be contacting fecal infected soil and getting it in deep wounds. When the child is walking would probably be a better time to consider this vaccine.

As I stated earlier, children can receive the "dead" polio injection, or the parents may decide that the background rate is low enough that they are willing to take a chance.

Mumps still occurs up to 13,000 cases annually. It is rarely fatal in children (only in immune compromised children). The real danger of mumps is actually to adolescents and adults, who can suffer sterility, deafness, encephalitis, and even death. The documented length of immunity derived from immunization is 10 years, so vaccinated children's immunity is waning just as they enter the age when the disease is most dangerous. Naturally acquired immunity is most often life long, so a child is probably better off getting the disease (which will be annoying but not dangerous) as a child and being protected as an adult. Same reasoning goes for Rubella (German measles). Regular Measles is a little trickier because there are still about 3, 000 cases/year and the case fatality rate is around 1 per 1000. So parents are taking a slightly larger chance by allowing their child to develop the disease naturally. However, reputable public health sources attribute most of the mortality from the disease to poor nutrition, so a health well-nourished child is unlikely to develop serious consequences.

Ok, so you either give the dead polio vaccine or no vaccine, you hold off on the hepatitis and tetanus injections, you let the kids get measles, mumps, and rubella on their own, what do you do about Diphtheria and Pertussis? The pertussis component of the DPT vaccine is responsible for much of the controversy surrounding immunizations. There are documented cases of death, and rates of encephalopathy resulting in permanent neurological. Pertussis disease still occurs about 3,500 cases/year, with about 10 deaths, mostly in otherwise healthy children under one year of age. So the disease causes many more deaths than the vaccine (but it is still tragic that an intervention designed to protect health causes morbidity and mortality). The new acellular pertussis vaccine seems to be an improvement, because the old vaccine was a very dirty thing and contained all kinds of cellular debris. The acellular vaccine still causes a large number of reactions such as fever and persistent crying (approx. 20%). So far, there have been no reports of more serious reactions such as encephalopathy, but the vaccine is still pretty new.

Diphtheria is now very rare (15 cases/year). The reported case fatality rate is 2%. The disease is very serious, causing a membranous covering to form over the pharynx which can lead to asphyxia. There does not seem to be much of a problem with the diphtheria vaccine by itself, and some peds are willing to procure single vaccines for parents who want to avoid the pertussis and tetanus vaccine and just give diphtheria vaccine.

For people who are interested in learning more:

Vaccines by Plotkin & Mortimer. WB Saunders.

A medical reference book that is readable enough for lay people. The authors are highly biased in favor of vaccines. History of vaccine development, epidemiology of natural diseases, adverse effects of vaccines. This book provides the kind of information she is looking for.

When I approached my local public health department about my need for research papers showing the effectiveness and safety of vaccinations they were unable to provide them. I explained that I work with a very discerning group of students and that I needed to balance the abundance of anti-vaccine info that I had obtained with well written, scientifically substantiated info on the value of vaccines. They sent me propaganda brochures without a single reference. I called them back to re-explain my need and was told that nothing like that existed to their knowledge.

Adverse Events Associated with Childhood Vaccines
Adverse Effects of Pertussis and Rubella Vaccines. Institute of Medicine,
National Academy Press.

The most comprehensive review of the scientific literature on vaccine safety to date. Very medical language, probably not readable by most lay-people, but good reading for practitioners.

Physicians Desk Reference

Details of reported adverse effects of vaccines,from the package inserts. Hint: vaccines are listed in the index under "biologicals" (it took me over an hour to figure out how to find vaccines in the PDR).

The Immunization Resource Guide. Diane Rozario. Only available from Patter Publications (800) 356-9315

Very informative and not inflammatory. Review of the current literature, state by state legal guide to vaccine refusal, very helpful guide to sources of further information. Of all the books I read in my research, this is the one that seemed most fair and helpful to parents searching for answers.

Vaccinations: The Rest of the Story. Mothering Magazine (800)827-1061

This book has gone in and out of print over the years, but is currently available again. Collection of articles, letters by parents and medical practitioners reviews the debate over vaccines quite thoroughly. Also Mothering published a single issue last year devoted to the topic. Don't know if the book has been updated to include information from that issue, be sure to ask if you call to order and get the issue if you can.

The Immunization Decision. Randall Neustaedter.North Atlantic Books.

A fairly balanced look at vaccines and alternative treatments. Most of his conclusions are based on reliable scientific sources (I went and got all the references listed by all of the authors who's books I review here--whew it was a lot of work). Some of his conclusions are a bit shaky, such as suggesting the current low rates of disease justify refusing vaccines, ignoring any possible role of vaccines in reducing incidence. Logically laid out and easy to read, with references.

How to Raise A healthy Child in Spite of your Doctor. Robert Mendelson. Ballantine Books.

One chapter (without references) which outlines the argument against routine vaccinations. However, he gives parents easy to follow information on childhood illnesses and how to evaluate when to seek medical care. I consider it a must for non-vaccinating parents.

Vaccines: Are they really safe and effective. Neil Miller. New Atlantean Press.

A highly inflammatory rant against vaccines. Relying primarily on poorly referenced anti-vaccine books, he nonetheless makes a persuasive argument that vaccines are dangerous and unnecessary. He brings up valid points for consideration and further research. Be prepared for any faith you have in the medical establishment to be shaken by this book. I would not recommend it as the first book inquiring parents should read,because it is not reliable information, although it is thought provoking. Very popular among anti-vaccine activists.