To vaccinate or not to vaccinate-2015

editors’ note

This article’s views do not necessarily reflect those of Contemporary Pediatrics, the editors, or the Editorial Advisory Board.

For a retired pediatrician, the present discussion about vaccinations after the Disneyland measles outbreak brings back a deluge of memories. How times and, yes, people have changed.

I started my pediatric training in an emergency [department] in July 1954, in Philadelphia. Each day we saw between 2 and 5 patients, sitting in the tripod position on the examination table with obvious poliomyelitis. Following a quick lumbar puncture to rule out bacterial disease, each [patient] was checked for evidence of paralysis, and if none was evident, [he or she was] sent home, with instructions to return immediately if any limb weakness occurred. Like in all the previous summers, the city and parents were in a panic. “Stay out of crowds! Don’t go to the swimming pools!” screamed the headlines in the newspaper.

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Later that year, I was called up by the US Air Force (Korea) and spent 2 years overseas as a flight surgeon. During those 2 years, the Salk polio vaccine became available, and soon thereafter Sabin’s oral polio vaccine came out-those wonderful sugar cubes with the pink drops on them. In my first year in practice, we had mass community oral polio vaccinations. People were fighting to get in line to get the drops for themselves and their children. Since those 2 years in the Air Force, I have seen only 1 patient with paralytic polio-an unvaccinated child of immigrant parents from Mexico. What a wonderful change!

During my pediatric training, I spent time at the old Philadelphia General Hospital infectious disease wards. Each ward had between 20 and 30 children. One ward was for diphtheria. Each day some of these children died, and new ones [were] admitted. The other 2 wards were for the “whoopers” and the “poopers”-whooping cough and severe diarrhea. The DTaP (Diphtheria, Tetanus, and acellular Pertussis) and rotavirus vaccines have made these wards obsolete.  

I started my private pediatric practice in 1959. During the winter months, I would see at least 2 to 5 cases of measles, 3 of chicken pox, and an occasional child with German measles (rubella) or mumps daily. Each month I admitted, and treated in hospital, at least 1 case of bacterial spinal meningitis and epiglottitis-deadly diseases now almost unknown. Pneumococcal sepsis in babies was common then, and often fatal.

Over the years as I practiced, the vaccines for these diseases were discovered and [made] available. Parents were clamoring to get these vaccines and protect their children. As “herd immunity” built up in the population, patients with these conditions gradually decreased and almost disappeared, so that nowadays physicians and parents have never seen a patient with a vaccine-preventable disease or known someone whose child has died from 1 of these diseases. “If I do not see it, it does not exist” is the present-day attitude of parents and some physicians.

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What parents and some physicians do not seem to want to accept is that as long as these diseases are not totally eradicated, and as herd immunity wanes, all these potentially deadly, preventable diseases will again become epidemic. We have seen this happen over the past few years with a resurgence of whooping cough and recently the Disneyland measles outbreak. Luckily, no measles deaths have occurred. If an outbreak of polio or diphtheria should happen, and there is no reason why, with low herd immunity, it will not eventually take place, there will be cases of paralysis and death.

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What is the answer: to vaccinate or not? How should the present-day pediatrician, who has never seen a case of these diseases or who has never informed parents that they have lost a child from them, react? Some of my peers dismiss non-vaccinating families from their practices. This just punishes the innocent child who is deprived of good pediatric care. Often, with patience, as the family comes to trust the new pediatrician, many of these families can be convinced that vaccines are not dangerous and so very necessary.

Under our constitution, parental rights have to be preserved. However, so have the rights of the general population, which is put directly at risk by vaccine opt-out parents. So maybe it is time for all state legislatures to step in (as they have in some states) and provide a decision.  

Yes, parents have the right to refuse vaccination for their children, but to protect other parents’ and children’s rights, these families must then accept the consequences of their decision: no admittance to public preschool, school, college, or workplace. This is the logical choice that parents have to accept. It is not right to choose for yourself and your child and thereby put the remaining populace at risk.

I hope that the members of the state legislatures will decide appropriately. Pediatricians should be the bully pulpit for this [cause]. All our children need to be protected, and it is important to preserve herd immunity to keep us all safe.

HERE’S ANOTHER REASON TO GET VACCINATED AGAINST MEASLES

The recent measles outbreak at a California theme park has exposed the gap in herd immunity for this vaccine-preventable contagious disease.

According to the Centers for Disease Control and Prevention’s latest report, updated May 8, 2015, 169 persons from 20 states and the District of Columbia contracted measles between January 1, 2015, and May 1, 2015, of which 117 cases (70%) were directly attributed to the California park. The majority of these persons was unvaccinated or had an incomplete history of measles vaccination.

Now there is evidence that the measles virus affects the immune system, leaving the infected person vulnerable to other diseases for as long as 3 years. The findings contradict the common argument that measles is a “benign” childhood disease and that natural infection strengthens kids’ immune systems.

Investigators found that the immunosuppression known to occur with measles infections lasts much longer that previously suspected. The team examined databases from the United States, Denmark, and Great Britain and found the pattern that mass vaccination for measles led to a drop in deaths from other infections. The data suggest that measles infection depletes the T-cell “memory” responsible for immunity against repeat infection, and that when measles is widespread, it appears to reduce herd immunity against other infectious diseases as well.

Mina MJ, et al. Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality. Science. 2015;348(6235):694-699.

Dr Weinberg is a retired pediatrician in California.