National Immunization Awareness Month

WHAT EVERY PARENT NEEDS TO KNOW ABOUT VACCINES

JoANN C. ROHYANS, MD, FAAP

August is National Immunization Awareness Month.  As summer vacation winds to a close, parents should be aware that they need to check their child’s vaccination record.  Vaccines (or immunizations) are recommended for people of all ages (from newborns through adults) and are the best way to keep children and adults healthy.  Through social media and television, we are all bombarded with tons of “quasi” medical information.   Unfortunately, parents don’t always know to whom to listen.  Not only are there doctors on television talk shows, news programs, Twitter, Facebook and blogs, but there are also celebrities and broadcasters who feel compelled to offer their advice regarding the immunization program. 

The best advice should come from a trusted medical source, primarily your physician.  The Institute of Medicine (IOM) has released two very important reminders.  One is that the MMR vaccine is NOT associated with autism and the other is that the current vaccine schedule (2013) is SAFE and best to be given on the schedule as it is written. 

Parents often ask if we can change the vaccine schedule to give fewer shots at each visit.  This is not recommended. Very good research shows that the number of vaccines given at one time does not increase side effects.  Instead, by using “alternative schedules,” parents leave their children vulnerable to very dangerous diseases. 

It can be confusing to parents since both the media and some doctors often speak of alternative schedules as if they are actually approved alternatives.  However, parents should be aware that there is only one official vaccination schedule.  This vaccination schedule is recommended both by the American Academy of Pediatrics and the Center for Disease Control.

It is also understandable that many parents feel overwhelmed and confused by the increase in the number of vaccines children and adolescents receive these days.  By age 2, a child can receive up to 24 injections and 2-3 doses of an oral immunization.  Luckily, combination vaccines can significantly reduce the number of injections without decreasing their efficacy.  But even so, it certainly does sound like a lot until you realize that we are able to protect against 16 diseases, all of which can be serious -- often causing hospitalization or even death. Because the vaccine program has been so successful in decreasing the incidence of many of these diseases, vaccine discussions in the media today often loose sight of how serious these diseases or their sequela can be.

This can lead to parents feeling ambiguous as to whether or not they should vaccinate their children.  It is not uncommon in my practice for a parent to ask, “Why does my child need a vaccine if the disease is almost eliminated from the U.S.?”   Unfortunately, diseases can have resurgences and when that happens the disease can spread quickly between countries and infect unvaccinated individuals. For example, in England in the late 1990s, parents chose not to give their children the measles vaccine.  Over the next 7-10 years, the incidence of measles increased dramatically especially in those unvaccinated.

What the vaccine discussions in the media and on-line often lack is a sense of what the world would be like without these vaccines. I saw many of the diseases now considered vaccine preventable when I was a child and more recently during medical school, residency and in my pediatric practice.  I have seen infants and children die of varicella (chicken pox) and its complications, which can include severe skin infections, blood stream infections and even central nervous system infections.  Before the rubella (German measles) vaccine became available, infants born to mothers who had rubella during their first trimester of pregnancy had a 50% chance of being born deaf, blind or having heart disease. 

I remember vividly a call from a mother on a Sunday morning saying that her child had developed a fever during the night, woke up having a seizure and was admitted to the hospital with meningitis and subsequent severe brain damage due to the Haemophilus influenza bacteria (HIB). This was just a few months before the HIB vaccine became available.  I also remember a young nurse with a chronic cough.  Her ill five week old was later admitted to the hospital and placed on a breathing machine.  It turns out her chronic cough was pertussis (whooping cough) and she had passed it to her baby. 

The diseases that we vaccinate against are real and serious. So as we enter August and prepare to go back to school, check that everyone in your family -- children, adolescents and adults -- is up to date on all their immunizations and booster shots. Furthermore, if you have any questions about vaccines, your doctor is a far better resource for medical information than the media.

The Injustice of Immunization Interviews

Wendy Sue Swanson, MD, MBE, FAAP
Author, Seattle Mama Doc Blog

When Dr. Wakefield interviewed on "Good Morning America" in January, an injustice occurred. It occurred inadvertently, I suspect, yet this injustice happens frequently in the world of pediatric health messaging. The stories the media covers, clearly change how we think and feel in regards to protecting and parenting our children. Their work to inform and educate, just like that of physicians and nurses, can get lost and misconstrued. ABC worked hard to inform us of the accusations against Dr. Andrew Wakefield with a 2-minute introduction by Dr. Richard Besser, a pediatrician and medical editor/correspondent. Yet, when the interview was over, we are left remembering the myth.

Dr. Wakefield interviewed with George Stephanopoulos who later labeled the interview "combative." Mr. Stephanopoulos was given a terribly difficult task. He was interviewing Wakefield on one of the most complex, emotional and loaded quandaries of the last few decades: vaccine-hesitancy and Wakefield's purport linking vaccines to autism. When Wakefield failed to deny any allegations and failed to discuss the significant research refuting his work, Mr. Stephanopoulos had to defend science. Alone. Although Stephanopoulos isn't gaining popularity (read the comments) with the anti-vaccine crowd, the 7-minute interview simply stirs the pot. I trust it had huge viewership. I worry that this is why it was done.

We need to discuss immunizations in the context in which decisions for vaccinating are made. In 2011, interviewing Wakefield alone on national TV doesn’t help. Wakefield’s myth and legacy regain power with each second he's on the news. We need to acknowledge the fear that has arrived on parents' doorsteps because of Wakefield's work. We needed a general pediatrician, a parent of immunized children, and a vaccine expert in the interview too. We need voices of reason. We need to frame issues surrounding immunizations truthfully. Although Wakefield's original study only applied to the MMR he has fueled millions of parents to distrust all vaccines. Dr. Wakefield claims that he doesn’t want others to stop immunizing against pertussis, but this point is easily lost. Stephanopoulos needed to make that point clear. In the office, when parents who are hesitant about immunizations talk about their worry, they point to Wakefield's claim.

Dr. Besser's introduction included micro-interviews (sound-bites) from Dr. Paul Offit and Seth Mnookin (book author of The Panic Virus). Neither was given the time and exposure Wakefield received. What we learned from Offit and Mnookin about immunizations could easily be forgotten by the time the interview with Wakefield was over.

Interviews, such as this one, leave parents increasingly more confused, not more informed. Although some bloggers are declaring vaccine-hesitancy dead with BMJ’s expose on Wakefield's work, we're far from seeing its end. Distrust in our physicians and nurses only increases when stories and interviews occur in this fashion. I suspect I will be helping families concerned about immunizations for the rest of my clinical career.

It can take only seconds to create a myth. It can take decades to rebuild the truth.

The editorials in The BMJ uncomfortably put Wakefield back into the spotlight. His message, although rebuked, regains momentum. Regardless of the scientific findings that vaccines have not been found to cause autism, Wakefield "won" the January interview.

Seven minutes alone in front of millions is power.

Viewership is the economy of television. If you want to get people to watch, putting Dr. Wakefield in the hot seat is a great way to start. And that’s where the injustice occurs.