Go Vaccinate.

So, measles and the MMR vaccine are pretty hot topics right now. Being board certified in pediatrics and allergy/immunology, I feel I am fairly qualified to talk about vaccines. I say that because one huge problem I hear from parents is the frustration about the VOLUME of information out there and they don’t know whom to believe. Some of you may say, ”Clearly your doctor should be the go to source,” and while I definitely agree with that, I can’t ignore the influence of Dr. Google and the fact that there may be actual doctors out there giving advice that directly contradicts the established medical consensus/guidelines. So, that is why I preface this post with my credentials. For the confused parents out there – know your sources. I won’t deny a mom’s natural instinct, but when it comes to things that are well-studied scientific conclusions, you’ve got to verify your sources!

With the vaccine “debate”, there are several ways you can discuss this, and I think the most effective way is to figure out WHY people don’t want to be vaccinated. Most people just want to do the right thing for their child. So, the question becomes “what has swayed this small group of people to be different from the majority of the population?” I thought about it, and there are four main groups: 1) patients who are unable to get vaccinated (medical contraindications, young age, etc.), 2) people who think vaccines will harm their children by causing autism, seizures, etc., 3) people who want to be as “natural” as possible without extra Western medicine, 4) people who want personal choice with absolutely no limits. I think by addressing each of these groups I’ll be able to present the facts that might best fit each group separately versus throwing ALL of the information at them.

1) This first group just can’t get vaccinated. Whether due to a true allergic reaction (extremely rare but it happens) or due to an immunodeficiency (either inherited or from chemotherapy), getting vaccines would cause death or significant harm. There’s no argument here. The main issue is continuing to do research to narrow down exactly who can and cannot get vaccines. A great example is complete and partial DiGeorge patients – research I worked on in 20081 shows that some of these patients can indeed be vaccinated and protected!

2) The next group has been inundated with the wrong information and need the plain facts. For the record, the MMR vaccine DOES NOT CAUSE AUTISM, but let’s delve a little deeper. The safety of the vaccine has been shown over and over again in various studies2-6. The association to autism mentioned in the Lancet journal article by Andrew Wakefield (subsequently retracted7-8) used guests at his son’s birthday party as samples (hardly non-biased), and in addition to losing his status as a physician, he has made money on promoting his anti-vaccine stance by speaking at various anti-vaxx conferences. As a “source,” he is far from credible.

3) The third group would be the ones that want to remain “natural.” I put natural in quotes because I am all about “less is more” and using medications ONLY WHEN NEEDED – that’s what I define as natural. So when people say they don’t want to vaccinate to remain “natural,” they disregard a century of medical advances and are absolutely wrong. When vaccinated patients go to the doctor’s office with a fever, cough and runny nose your doctor may shrug it off and say it’s viral – and we can do that ONLY IF you’re vaccinated. When an unvaccinated child comes to the office with fever, cough and runny nose we need to do a full workup to ensure your child is not infected with serious and extremely contagious illnesses that can cause blindness, brain damage, and, at worst, death, even with the proper treatment. I would much rather administer a vaccine so a patient can develop a NATURAL immunity to these viruses rather than worry that a patient is not protected and need to do an extensive, UNNATURAL workup.

4) The final group is the personal choice advocates. Often, it is unclear to me, as their physician, why this group does not want to vaccinate, as they often have no specific rationale – just that it’s their “personal choice.” I often educate these families on the concept of herd immunity. Herd immunity is what helps vaccines work, even in unimmunized patients. This illustration from the National Institutes of Allergy and Infections Diseases (NIAID) does a great job of demonstrating this principle.

Photo credit: The National Institute of Allergy and Infectious Disease (NIAID)

Photo credit: The National Institute of Allergy and Infectious Disease (NIAID)

You can see if there is a large group of vaccinated people, then even unvaccinated patients (such as the very young or immunodeficient) are protected. But otherwise, only vaccinated patients are protected, and the biggest losers here are the people that CAN’T get vaccinated. So while this illustration showcases the science of vaccines, it also really just boils down to the common good – by all of us working together, we really can protect the most defenseless amongst us.

I know there are more arguments and points of view that can be brought up here, but the quick and dirty is this: facts, science, and morality are on the side of vaccines. Go vaccinate.

Resources:

  1. Development of specific T-cell responses to Candida and tetanus antigens in partial DiGeorge syndrome. Davis CM, Kancherla VS, Reddy A, Chan W, Yeh HW, Noroski LM, Rosenblatt H, Shearer WT, Chinen J. J Allergy Clin Immunol. 2008 Dec;122(6):1194-9.
  1. MMR and autism: further evidence against a causal association. Farrington CP, Miller E, Taylor B. Vaccine. 2001 Jun 14;19(27):3632-5.
  1. Safety of vaccines used for routine immunization of U.S. children: a systematic review. Maglione MA, Das L, Raaen L, Smith A, Chari R, Newberry S, Shanman R, Perry T, Goetz MB, Gidengil C. Pediatrics. 2014 Aug;134(2):325-37.
  1. Immunization Safety Review: Measles-Mumps-Rubella Vaccine andAutism. Institute of Medicine (US) Immunization Safety Review Committee; Stratton K, Gable A, Shetty P, McCormick M, editors. Washington (DC): National Academies Press (US); 2001.
  1. Vaccines are not associated withautism: an evidence-based meta-analysis of case-control and cohort studies. Taylor LE, Swerdfeger AL, Eslick GD. Vaccine. 2014 Jun 17;32(29):3623-9
  1. Adverse Effects of Vaccines: Evidence and Causality. Committee to Review Adverse Effects of Vaccines, Institute of Medicine; Stratton K, Ford A, Rusch E, Clayton EW, editors. Washington (DC): National Academies Press (US); 2011 Aug 25.
  1. Wakefield’s article linkingMMRvaccine and autism was fraudulent. Godlee F, Smith J, Marcovitch H. BMJ. 2011 Jan 5;342:c7452.
  1. Lancet retracts 12-year-old article linkingautismto MMR vaccines. Eggertson L. CMAJ. 2010 Mar 9;182(4):E199-200.

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