According to the Associated Press in eight states, more than 1 in 20 public school kindergarteners aren’t getting all the vaccines required for attendance. Why is this?
While the safety of vaccines has been proven in many studies, parents may doubt the safety of vaccines. Many parents have noticed a temporal correlation between the first signs of autism and the routine childhood vaccination schedule but the correlation has been proven to be unfounded. A review study by Doja and Roberts (2006) shows there is no causal association between the MMR vaccine or the vaccine preservative thimerosal and autism.
Could lack of education or resources play a role in the decision to not vaccinate a child? The profile of a parent that decides not to vaccinate is middle-class, college educated and web savvy according to Dr. Nancy Snyderman, the Chief Medical Editor for NBC in an article by MSNBC, indicating that lack of education and resources do not play a role in the decision to not vaccinate.
Dr. Nancy Snyderman implies it is rather the fact that these new parents do not have any memory of measles, mumps, polio or whooping cough outbreaks; therefore they do not see the necessity of vaccinating their children for these diseases. While the prevalence of these diseases are decreased they still are a risk with 24 children dying of whooping cough last year in California.
This decision to not vaccinate not only affects the unvaccinated children but puts others at risk as well. Unvaccinated children could potentially infect infants too young for vaccines and people with compromised immune systems such as the elderly or chemotherapy patients.
It is a personal choice as to raise a child and what to expose them to but with the pros outweighing the cons in this situation, is the right decision to vaccinate or to not vaccinate?
Asif Doja and Wendy Roberts. (2006). Immunizations and Autism: A Review of the Literature. The Canadian Journal of Neurological Sciences, 33:341-346
http://moms.today.msnbc.msn.com/_news/2011/11/29/9090395-are-opt-out-parents-and-unvaxxed-kids-a-health-threat
The other day I was in a class and we had a debate about vaccines and the idea of herd immunity or "community immunity" came up. I think that it is important to look at how community immunity can help to decrease the number of disease carriers and possibly get rid of many bacterial infections. And if you are not vaccinating your children or yourself, you are not adding to the herd immunity. Here is an interesting article I read on the topic:
ReplyDeleteCrislip, Mark. "Science-Based Medicine » Herd Immunity." Science-Based Medicine. 5 June 2009. Web. 29 Nov. 2011. .
Dr. Andrew Wakefield was responsible for the scare regarding the MMR vaccine and its possible link to autism. We discussed this same topic for a good two hours in a biomedical ethics course. “The paper he wrote on the study said that no causal connection had been proven, but before it was published, Wakefield made statements at a press conference and in a video news release calling for a suspension of the vaccination until further studies could be done” (Deer). As we all know once media catches wind of something news spreads like wildfire and the "general public" takes every word as reliable. He has since been banned in the UK from practicing medicine.
ReplyDeleteWhile I agree very much that knowledge is power, I do not agree with the idea that people always behave according to what they know. Many people have heard of this man and/or the falsified claims he made, especially college graduates, yet there are still a significant number of people that act to the contrary. They've heard about the falsification of his claims and yet still choose not to vaccinate their kids. This counterintuitive act is not only limited to vaccinations. Other health concerns such as HIV/AIDS transmission appears to work in the same way. I do not believe there are many, if any, Americans who don’t know how to prevent themselves from contracting HIV, yet there are many people who choose to behave counter intuitively to what they know. Condoms and clean needles are, in essence, the vaccination for HIV. How do health professionals get people to act in ways they know will keep them healthy? The general public can be given all the flyers and pamphlets they can handle, so the knowledge is there, but how do we get them to behave according to their knowledge?
Reference:
Deer, Brian (1998-02-04). "Interview: Dr Andrew Wakefield, research team leader, Royal Free Hospital School of Medicine". http://briandeer.com/wakefield/royal-video.htm.
Although many parents have not vaccinated their children against well-known diseases, the number of children with autism continues to rise (mainly because of better diagnostic methods and education). Pediatricians largely associate the correlation between the onset of symptoms of autism and vaccination with the age of the child; symptoms that appear after vaccination likely occur not as a result of the vaccination, but with the age that the vaccination is administered. For example: at a year of age, children receive a round of immunizations. Around the same time, they begin to speak. Symptoms of autism are often first noticed in development of speech. Here, parents may confuse causation and correlation.
ReplyDeleteVaccination and autism has become a hot topic because of the quick media response. Dr. Wakefield, as you mentioned, first made the claim that there was a connection between vaccination and autism. His article was later retracted from the journal that published it and he was charged with fraud and altering data. Jenny McCarthy, former Playboy model and MTV star, strongly advocated for “nontoxic vaccine” after her son was diagnosed with autism in 2009. Dr Jerry Kartzinel co-authored Healing and Preventing Autism with McCarthy, which led many parents to refrain from vaccinating their children. (Dr. Kartzinel is a self-proclaimed “outcast” amongst pediatricians, who largely disagree with many of his claims.) It’s disturbing to me that parents are willing to put their children’s lives at risk despite the research they believe being in the minority. Doctors advocating for immunizations are bombarded by angry mothers of children with autism and who are backed by (the very small group) of pediatricians who oppose vaccinations. It’s hard for rational explanations to be heard when emotional ties are involved.
References:
http://www.plosbiology.org/article/info%3Adoi%2F10.1371%2Fjournal.pbio.1000114
And an interesting video:
http://www.youtube.com/watch?v=3e5PH1YzhKY&feature=related
While many parents do couple vaccinations and autism, the root of this argument could have stemmed from the presence of a variety of metals that are present within the vaccines. I know of parents that did not vaccinate not because of the fear of autism, but because they were not comfortable with the possible side effects of the Mercury present within certain vaccines. I am not aware of the current concentrations of Mercury in vaccines today, but in 1999 the FDA did a survey of the total amount of Mercury a child would receive via the following vaccines:
ReplyDelete75 micrograms of mercury from three doses of DTP,
75 micrograms from three doses of Hib, and
37.5 micrograms from three doses of hepatitis B vaccine;
for a total of 187.5 micrograms of mercury.
Being that Mercury can severely damage the brain, kidney, and lungs in large doses, certain parents are uncomfortable with it's presence in vaccines - and therefor do not vaccinate. If the effects of these metals were known and shown not to be harmful then we could see an increase in total children vaccinated.
Madrona M.D., Lewis M. "Vaccines: Vaccinations and Mercury in Vaccines." The Healing Center On-Line. 2008. Web. 01 Dec. 2011. .
The argument between Autism and vaccination is unclear, but the history of vaccines is very clear. In 1970s in the USA more than 10,000 children were paralyzed with polio, a viral disease that atrophies the skeletal muscles. Rubella, measles and diphtheria affected more than 4 million of children and killed 3000 children in the 1960’s. Vaccinations have been used in the prevention of diseases and routine immunization has eradicated smallpox from the globe and led to the near elimination of polio virus. Vaccines provide herd immunity, which according to the Center for Disease Control and Prevention, it refers to a large percentage in the population that gets vaccinated and helps to reduce the spreading of diseases. In addition, herd immunity provides protection to individuals that are not vaccinated, because there is a low probability of disease spreading. On the other hand, herd immunity has potential risks, such as resurgence of the disease that was prevented by herd immunity. A significant percentage in the population, believed that immunization effects last forever. The CDC indicates that childhood immunizations fade over time therefore the need of a buster vaccine during adulthood. The CDC recommends that adults get vaccinated against many common illnesses such as tetanus, diphtheria and pertussis. The advantage of vaccines is to prevent illness and secondary infections that may result from the disease, reducing the severity of the illness and mortality. In the case of the influenza vaccine, every year a new vaccine is developed because the virus strain mutated every year. The influenza pandemic made hospitals and health care personnel to get vaccinated and protect the patients, worker population, and the overall community. Most Americans who die each year from vaccine preventable diseases are adults, vaccines are not infallible, but are the most effective way to prevent the spreading of disease, then why not get vaccinated and be able to protect yourself, your family and the rest of the population. Immunization protection cannot be taking for granted in my opinion.
ReplyDeleteReferences:
http://www.cdc.gov/vaccines/recs/default.htm
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ReplyDeleteI recently had a heated debate about this very topic over my Thanksgiving holiday. My cousin’s new fiancé does not believe in any kind of modern medicine and he himself has never had a vaccine . I was quite alarmed to hear and asked my cousin if she planned to vaccinate their future children. She very quickly said no stating her main concern, like many parents, was the correlation of autism and vaccines. I quickly took to the computer to show her the article published in BMJ showing that famous, Dr. Wakefield research was fraudulent and that his medical license has since been revoked(Godlee, Smith, and Marcovitch, 2011). Wakefield was found guilty of serious professional medical misconduct and his paper withdrawn from the Lancet. He falsified scientific data, which lead to a great decrease in the vaccination rate in the U.K and Ireland. The decrease in vaccination rate caused a great increase in MMR related deaths and debilitation (Godlee et al.) Furthermore, I explained that without vaccines we would not have eradicated small pox and nor gotten control over the permanently debilitating disease polio. I did convince my cousin that vaccines were a good idea but as far as the general public is concerned I think it’ s important for providers to explain how vaccines work and that there is an unfortunate correlation between the age at which a child gets there vaccines and the diagnosis of autism. In science, correlation does not equal causation and in this case, it is very pertinent that parents understand . As a physician, you obviously can’t force a patient to make any decision however I do think presentation of the following facts would help. Firstly, Dr.Wakefield’s research being deemed a modern day Piltdown by several creditable medical journals(Godlee et al) secondly, the institute of medicine states that the benefits of vaccines greatly outweigh the cost and lastly the report of the number of deaths from measles in San Diego in 2008(Smith, Ellenberg, Bell, Rubin 2008). If all else fails money talks, some providers and insurance companies have suggested charging higher premiums for individuals who aren’t vaccinated(Rahul 2011). This mainly stems from the fact that in San Diego alone it cost 10,000 dollars per case during the measles outbreak(Rahual).
ReplyDeleteGodlee F, Smith J, Marcovitch H (2011). "Wakefield's article linking MMR vaccine and autism was fraudulent". BMJ342:c7452 (jan05 1): c7452. doi:10.1136/bmj.c7452.
Smith MJ, Ellenberg SS, Bell LM, Rubin DM (April 2008). "Media coverage of the measles-mumps-rubella vaccine and autism controversy and its relationship to MMR immunization rates in the United States". Pediatrics 121 (4): e836–43.
Rahul Parikh, "Make anti-vaccine parents pay higher premiums", CNN 20 January 2011