Vaccinations

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One of the concerns parents can have about their children is whether or not vaccinations are safe. Some parents have already made up their minds and don’t want vaccinations for their children. Others aren’t quite sure and would like my opinion. Regardless of a parent’s view on vaccinations, I must make clear, I will take excellent care of them and their child. While I am a strong proponent of vaccinations, I believe that children who have not been vaccinated need good medical care just like children who have been vaccinated. There are parents who want vaccinations for their children, but want to take them more slowly than the recommended course. I am willing to work with parents to get vaccinations for their child. My hope is that parents will come to trust me enough to take my recommendations for vaccination—but I will never force the issue.

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As a physician and scientist, I highly recommend vaccinations for every child who can receive them. They are well supported by the evidence, and the Andrew Wakefield study that spurred much of the vaccine controversy starting in 1998 was ultimately proven to be fraudulent, and based on his desire to sell his own MMR vaccine. To better understand the importance of vaccinations we need to take a trip into history. The first vaccination is commonly attributed to Edward Jenner in 1796 with the use of the cowpox vaccine to protect against smallpox. However, there is actually evidence that as early as 1000 A.D. the Chinese were using inoculation with bits of smallpox to protect against this highly contagious and deadly disease. Prior to successful vaccination, the mortality rate of smallpox was 30% – and 60 to 70% of survivors were scarred for life, some even left blinded.

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In the early 1900s the US child mortality rate was roughly 25% before age 5, dropping to 4% in 1950 and now down to 0.7%. It would be disingenuous to attribute all of this reduction, since 1900, in mortality to vaccination. Decrease from 1900 to 1950 is largely due to better sanitation, clean drinking water, safer food, and overall improved hygiene. However the reduction from 1950 to today can be attributed almost entirely to vaccinations. In 1950, roughly 40/1000 children in the United States died before age 5. Today less than 7/1000 children die before age 5. Further, as more children are being vaccinated with Hib (Haemophilus influenza type b), child mortality from meningitis and HIB pneumonia have become virtually nonexistent. In my near two decades of practice, I have yet to diagnose a child with bacterial meningitis, and I have certainly never seen a child die from Hib – none of my emergency medicine colleagues who started practicing before 2000 can say that.  

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The vaccine disparaged by Wakefield, Measles Mumps and Rubella (MMR), has probably had the greatest impact on childhood mortality of all vaccines. In the 1960s, researchers were surprised to realize that in areas where measles vaccination is prevalent, all-cause mortality reduced by up to 50%. This is because measles essentially erases and resets the immune system. Therefore, infectious diseases that children had already become immune to suddenly became much more deadly for children than they were the first time. In one of the greatest ironies of the Wakefield paper, 33/100,000 children who were diagnosed with measles ended up with severe neurological complications including mental retardation and permanent damage to the central nervous system (brain and spinal cord). Measles, almost eliminated in the US and on the decline around the world, is making a comeback due to the anti-vaccination movement energized by the Wakefield report.

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So many studies have been done to determine whether there really is a connection between autism and the MMR vaccine that it is now beyond all doubt that there is no connection. The MMR vaccine does not cause autism. I also get objections to some of the preservative agents and adjuvants. Adjuvants, like aluminum, help the vaccine provoke a stronger immune response. Aluminum is actually found in breast milk, food. The amount of aluminum found in vaccines is actually less than what the child is exposed to from breast-milk and other food during the first six months of life. Preservatives, like Ethylmercury (Thimerosol) also cause concern. Thimersol is only found in influenza vaccines and, unlike the methylmercury found in fish, is easily broken down and quickly excreted from the body. Further, Thimerosol-free influenza vaccines are available to those who prefer them.

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Another objection I commonly get is to combination vaccines. Combination vaccines have several benefits. They allow for fewer shots and less discomfort for the child. The side effects are equivalent to single vaccines, but with lower risk overall due to fewer shots. They have also enabled parents to more easily get all the vaccinations their child needs with fewer visits to the doctor and less overall cost. They also pose no greater risk than individual vaccines. They do have a higher rate of febrile seizure, but, taken as a whole compared to individual vaccines, it is about the same. Further, febrile seizures are quite common in children during infections of all kinds and are usually self-limited and benign (not dangerous).

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One of the problems with refusing vaccines for your own children is that, in addition to putting them at greater risk, parents are putting other children at greater risk. It is because of this public-health risk, and the recurrence of previously well-controlled diseases, that many states are going to mandatory vaccinations for school-children—with exceptions only for medical reasons or very specific, and verified, religious reasons. California’s immunization requirements are now quite strict. There are no religious or philosophical exemptions allowed, and physicians (MD or DO only) are required to cite the specific reason a medical exemption is required for each vaccine for which the child requires an exemption. Children in private home-schools or doing online-school only are exempted.

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Many of my patients and friends are asking me about whether or not I think they should get the COVID-19 vaccination, if and when one becomes available. Generally, I would say yes, but can only really answer the question once the phase 3 trials are completed and I have a chance to review them for safety and effectiveness. As in anything I recommend to my patients, I will very carefully weigh the risks and the benefits of the treatment for each specific patient before I advocate it. I will say that once I am convinced the vaccine is safe and effective, I will get it for myself and my family as soon as it becomes available.

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Finally, I will say that if parents or patients are disinclined to get the full range of vaccinations, that the bare minimum would be the DTap (Tdap for adults) vaccine and MMR. This is because tetanus is everywhere in our environment, in soil and on rusty nails, and MMR helps prevent measles, which in turn helps prevent all-cause mortality in children. Diphtheria is an included vaccination and is a disease once frequently lethal in children that is now nearly eradicated. Pertussis, once a regular cause of death for infants, is now also quite rare because most adults are immune and it cannot easily spread.

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I and my family receive all recommended vaccinations when they come due. When my daughter is old enough, she will also get the HPV vaccine because the opportunity to prevent cervical cancer is a blessing I will not pass it up for her. We get the annual flu vaccine and we get our Dtap boosters when needed. I understand vaccinations, both the risks and the benefits, and the important point to remember is that while vaccines do have risks, they are rare and generally mild in comparison to the diseases they prevent.

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If you have any questions about vaccinations, please do not hesitate to e-mail me at DrEdwards@wowhealingcare.com or call at 760-425-4466.