Risk and Reward : A Vaccine Reminder
Amy Movius , MD
The start of the school year is a busy time. There’s new clothes, backpacks and supplies, registration, documentation of a physical exam and immunizations. Immunizations? Okay, SHOTS; that’s what we really call them. Currently, children should receive about 20 immunizations by 24 months of age.
No one likes “shots”, but they are critical to healthcare. Vaccinations have had a huge effect on worldwide health. Small pox has been eliminated as a clinical disease worldwide. The benefits are especially apparent in the US, where immunizations are readily available. In North America the incidence of previously common and devastating diseases such as diphtheria, tetanus, and measles has been decreased by 99%.
Some children in the US remain unimmunized, many by parental choice. The reasons for a parent making this choice can be varied. Ironically, the successful use of vaccinations in the US is certainly a factor. Most parents and grandparents have little to no personal experience with the severe diseases that were common only a few generations ago. Putting your child through a shot to protect against these now rare diseases can seem unnecessary. The problem is that these diseases are rare because vaccinations work, NOT because the pathogens, or “bugs” that cause them no longer exists. Some parents are concerned that immunizations are risky. For example, in a national survey 25% of parents thought that receiving multiple immunizations decreased the immune system. This is not true. The internet, a wonderful resource in many regards, can be the great vaccine MISinformation superhighway, as there are many websites describing unfounded dangers of childhood immunizations.
So let’s get to the facts. Vaccines are very safe, but not risk free or 100% effective. A low grade fever and some soreness at the sight of injection are common. Very rarely there may be a more serious reaction such as a very high fever, marked swelling at the site of injection, or body rash. There is NO evidence that childhood vaccines cause SIDS, autism, multiple sclerosis or other demyelinating disorders. When evaluating vaccine use, the risk of getting the disease if unimmunized is weighed against the risk of a serious side effect from receiving the immunization itself. If the chance of getting the disease is high, as in an epidemic, the choice is obvious. However, even in communities where the immunization rate is high & infection risk low, the risk of receiving an immunization is far less than that of getting the disease.
If a disease is rare, those who are not immunized are relying on “herd immunity” to protect them. This means that their risk of getting the disease is low only because they are surrounded by people who cannot infect them because they are immune via vaccination. This is a circular approach, however. When more people rely on herd immunity the number of people susceptible to getting the infection increases. This, in turn, leads to an increased prevalence of the disease and further risk associated with remaining unimmunized. This is exactly what has happened with pertussis, or whooping cough, which has been on the rise the last 20 years due to decreased immunization rates.
There are those who have no choice but to rely on herd immunity. In the case of whooping cough, infants are at greatest risk of critical illness or death. Most remain susceptible to this infection until they have received three shots, usually at 2, 4 and 6 months of age. People with immunodeficiency from cancer or other causes, as well as certain types of seizures should not receive some immunizations. Also, there is always a small number of people who receive vaccinations but do not remain immune. All of these persons are placed at even greater risk of disease by persons who remain unvaccinated by choice.
Sometimes parents decline shots because they are concerned about the cost, the number of shots given at a time or the pain their child will feel. Please speak with your provider about your concerns! Immunizations are not costly and are completely covered by many policies. Most providers can be flexible about spacing out shots over a number of days or weeks if desired. Likewise, strategies to minimize the pain and stress can be discussed. So please, get your children immunized for everyone’s sake.