NYT article on childhood immunizations.
October 3, 2000
Personal Health: For the Vaccine-Wary, a
Lesson in History
By JANE E. BRODY
Most parents now raising questions
about the safety and wisdom of
childhood immunizations have never
seen a case of whooping cough, polio,
measles or mumps. Parents now in their 20's
and 30's grew up in an era when they and all
their schoolmates were protected against
such serious infections by a series of
vaccinations administered early in life.
Few such parents realize that small children
can die or become brain-damaged from a
measles infection. They do not remember
when children were forbidden to swim in
public pools all summer so they would not
contract polio. Nor have they seen children
placed in iron lungs because polio had
crippled their respiratory muscles.
As a 59-year-old, I have a clear recollection
of these unfortunate events. I also clearly
recall my own experience with horrific cases
of chickenpox (scarred for more than a
decade), measles and mumps on both sides
of my face simultaneously. And I can still
hear the whooping coughs of a childhood
friend who developed pertussis and had to
be hospitalized in isolation.
Ill-informed hysteria about the safety of
current vaccines could once more bring
these awful childhood diseases to the fore.
To be sure, most parents who now resist
childhood immunizations are well
intentioned. They are only trying to protect
their children from purported serious side
effects that have been bandied about in print, on the air, on the floor of
Congress and now on the Internet. The Internet also offers guidance on how
parents can skirt the immunization requirements for entering school.
How accurate are the accusations against vaccines, and what price might we
pay for heeding them at the expense of the immunizations now universally
recommended by pediatric and public health officials?
A pro-vaccine Web site, www.Pkids.org, offers some cautionary statistics
regarding failure to immunize.
Before Vaccines
When I was a child, 13,000 to 20,000 cases of paralytic polio were reported
in this country every year. Now there are none. Before children were
routinely immunized against measles, nearly every American child got it —
three million to four million cases, resulting in some cases of measles
encephalitis and an average of 450 deaths a year.
The vaccine reduced measles cases by more than 95 percent. But as has been
made clear from outbreaks of measles that have occurred where rates of
childhood immunization were low, the scourge of measles can return quickly
and easily.
Whooping cough (pertussis), too, was nearly a universal occurrence of
childhood that killed 5 of every 1,000 children born in this country before
pertussis immunizations. From 150,000 to 260,000 cases were reported each
year, with up to 9,000 pertussis-related deaths. In the 1970's, the British
showed what could happen when pertussis vaccination rates dropped. After
questions were raised about the safety of the vaccine then in use,
immunization rates dropped to 60 percent in Britain and in the next few years,
a series of pertussis epidemics occurred, including one resulting in more than
100,000 cases and 36 deaths. And in Japan, by 1979 pertussis vaccination
coverage dropped to 20 percent from 80 percent, leading to more than
13,000 cases and 41 deaths.
Before we had a vaccine for Haemophilis influenza type b (Hib), 20,000
infants and children each year developed invasive Hib infections, two-thirds
of which resulted in meningitis, a disease that killed 600 children each year
and left many others with seizures, complete hearing loss or mental
retardation. The vaccine, introduced in 1987, has resulted in a decline in Hib
of more than 97 percent, to only 33 cases last year.
Parents who refuse to have their children vaccinated are basically counting
on the fact that most children are immunized, conferring a kind of herd
immunity. But as a serious outbreak of measles in Alaska shows, all it takes is
one child with an active infection to cause widespread problems among those
not properly immunized.
Last spring, in a Washington Post editorial, Dr. Julian Orenstein, a fellow of
the American Academy of Pediatrics who practices emergency medicine in
Fairfax, Va., warned colleagues to "bone up" about infectious diseases that
they thought had disappeared: measles, mumps, whooping cough. "They may
return," he said, because "some parents have stopped trusting the
vaccinations that kept those illnesses at bay."
Safety Concerns Answered
The concerns of parents, and some medical professionals, have not gone
unheeded. Although follow-up studies did not support British fears that brain
damage or sudden infant death could occur in rare cases after pertussis
inoculations, a new vaccine was developed that lacked the potential for such
an effect. While the old vaccine was based on whole cells, the new one is
acellular, made from only part of the infectious organism. The new vaccine is
associated with fewer minor side effects, yet it appears to be as effective as
the whole-cell vaccine in preventing whooping cough.
The switch from the original injected Salk polio vaccine to the oral Sabin
vaccine resulted in rare but serious cases of vaccine- related paralytic polio.
From 1980 to 1994, 124 American cases of vaccine-associated paralytic
polio were reported. The Salk vaccine was made from inactivated viruses
that could not cause disease. The Sabin vaccine, though easier to use and
highly effective, was made from live attenuated viruses, some of which
apparently retained their infectious potential. The current recommendation for
healthy children is administration of four doses of the inactivated Salk
vaccine — at 2 months, 4 months, 6 to 18 months and 4 to 6 years. The
resulting immunity is as good as with the Sabin vaccine, but the risk of
vaccine-induced polio is nonexistent.
With regard to measles vaccine, which is given along with vaccines for
mumps and rubella, no change has been made in either the vaccine itself or
its recommended administration schedule. Yet some parents suspect that the
vaccine or the combination of the three vaccines (M.M.R.), or some other
vaccine combination, is responsible for a rise in autism cases among infants
and toddlers.
Studies have found no causal connection between the vaccines and autism.
Rather, the autism cases seem to be coincidental with immunizations and
their rise could simply be a result of better recognition and diagnosis. Also,
though perhaps not noticed by parents or their pediatricians, symptoms of
autism are usually present at birth whereas the three-part M.M.R. vaccine is
administered at 12 to 15 months of age.
Copyright 2000 The New York Times Company |
