Skipping Vaccines is Bad Science

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Cherise Rohr-Allegrini with her ergo and her two children after a day of hiking. Courtesy photo.

Cherise Rohr-Allegrini with her ergo and her two children after a day of hiking. Courtesy photo.

“Crunchy,” “granola,” “hippie.” I wear these labels proudly. I am a home-birthing, extended breastfeeding, babyfood-making, co-sleeping, cloth-diapering, sling-wearing mom. I am also an infectious disease scientist and a public health professional that believes in evidence-based health practices. I know what happens when kids get preventable infectious diseases.

Prior to the licensing and widespread use of the measles vaccine in 1968, it was not unusual to have more than 85,000 cases of measles in Texas alone. Despite an outbreak of measles among college students in the early 1990s, which had a variety of causes, overall rates of measles declined drastically since the late 1960s.

Measles Cases the US from 1950-2001. Source: CDC.gov

Measles Cases the US from 1950-2001. Source: CDC.gov

In 1998, the World Health Organization declared that measles would be eradicated worldwide by 2007. In 2000, public health officials declared measles to be eliminated from the US. But instead of being eliminated, it returned with a vengeance: the CDC reported 11 outbreaks in the US in 2013.

In 2014 it’s been even worse, with Texas and California hit particularly hard. When one looks at the numbers, they tend to say “Ah, only a couple of hundred cases, that’s not much.” But what they’re forgetting is this: Measles kills. Like most vaccine-preventable diseases, it doesn’t always kill, but once we reach a critical number of cases, the likelihood that one of those children will die becomes much greater. For measles, that’s 500 cases.

It’s been many years since we’ve seen more than 500 cases in the US. But this year, as of May 14, there have been 216 cases in the US. Ever closer, we inch towards that critical threshold.

n 2014, 216 cases of measles have been reported in 18 states. Source: CDC http://www.cdc.gov/measles/cases-outbreaks.html

In 2014, 216 cases of measles have been reported in 18 states. Source: CDC.gov.

And it’s not just measles. The second M in MMR stands for Mumps. By May 27, 2014, there have been 464 cases of mumps in the U.S., most linked to outbreaks at Ohio State University and Fordham University in New York City.

And then Congenital Rubella (the “R” in MMR) rears its ugly head. For most of us, rubella is a mild illness, often not even noticed. But for pregnant women, it often results in the death of their fetus. If the baby survives, then there’s a high likelihood the baby will be born with severe abnormalities, all due to a preventable disease.

Pertussis is probably the most widespread vaccine preventable illness we see today. In 2000, if we’d seen more than 2,218 cases we saw in 2012, DSHS would have declared an epidemic. Today, this is the endemic level – the “new normal.”

Rates of Pertussis in Texas from 1990-2012. Source: Department of Health Services.

Rates of Pertussis in Texas from 1990-2012. Source: Texas Department of State Health Services.

“What’s pertussis?” you say, “Just a cough.”

For adults, that’s true. For tiny babies, it can be deadly. Babies can’t start the vaccine series until they’re two months old. My first case as an epidemiologist was a seven-week-old baby with pertussis. The child was too young for the first shot, and got sick: very, very sick, a difficult and tragic outcome for this family. There’s a good chance the baby had been in contact with an infected adult. There’s a vaccine available for adults. How many of us get it? Very, very few. Nationwide, adult vaccination for pertussis is around 16 percent.

In Bexar County, 65.7 percent children under the age of three have received all the required vaccinations.

That sounds pretty good, except when you learn that the US National Goal is 80 percent, and for some diseases, we need at least 90 percent of all kids vaccinated to fully protect the entire population.

Why? Why would anyone not prevent a disease when it’s so easily preventable?

Fear. Misinformation. Distrust.

Any one who is a parent knows that “mama bear” instinct. We all want to protect our child. An epidemiologist friend, a strong believer in vaccination, said she wanted to grab her child and run when the nurse brought out the needles at her baby’s two-month doctor’s visit. But she knew the greater protection came with vaccination.

It’s hard to see our kids suffer. It’s even harder to see them suffer when we don’t understand the cause. Dr. Peter Hotez, Director of the Sabin Vaccine Institute, has a child with profound autism. If any one knows first hand the challenges of an autistic child, it’s him. Yet, he leads the world’s experts in vaccine development and research while another one of his children studies the developmental psychology of autism.

Bexar County rates of vaccination fall below most of the state and well below the national goal.

Bexar County rates of vaccination fall below most of the state and well below the national goal.

It’s easy to call upon the Andrew Wakefields and Jenny McCarthys of the world when asking why people choose not to vaccinate. Yet, the public health community is also responsible. We failed to communicate the importance of vaccines. We failed to present the science in such a way that people would understand – really understand how important these vaccines are. Despite all the scientific evidence to the contrary, it’s hard to convince people once they’ve been scared into believing something, and now we have an uphill battle.

But we are also victims of our own success. In public health we often say that if we do our jobs well, no one knows about it. That’s what happened. We did our jobs so well that the rate of these vaccine preventable diseases declined. Cases declined so much that people in the U.S. felt they were no longer at risk. Except, in a world of global travel, every communicable disease is a risk. You don’t even have to travel, you just need to come into contact with someone who did; or someone who came into contact with someone who did.

Herd Immunity. Community Immunity.

A herd is a community. That would be us. Your child goes to school. He has a friend whose parents chose not to vaccinate. That friend becomes sick and he passes the infection on to anyone susceptible. No vaccine is perfect, most range form 80-90 percent effective, some less. Some kids, even though they’ve been vaccinated, may not be protected. Then there are the kids who can’t be vaccinated because they have immune disorders that make them ill if they’re vaccinated.

Cherise Rohr-Allegrini carrying her 3-month old daughter in her favorite sling. Courtesy photo.

Cherise Rohr-Allegrini carrying her 3-month old daughter in her favorite sling. Courtesy photo.

To prevent those kids from getting sick, we have Community Immunity. That’s a trick we play on the infections. If 90 percent of us are vaccinated against measles, the virus can not persist in the community. This is how small pox was eradicated and why it was believed that measles could be eradicated Measles, especially measles, should be very easy to eradicate – it’s a single strain, we mount a significant and what appears to be life long immune response.

The virus isn’t smart enough to play tricks on us. All we have to do is vaccinate 90 percent of the population. Instead, in the U.S., one of the most developed nations, our rates hover around 60 percent.

Do we really want a return to the 1950s, when 85,000 kids had measles and a death rate of 20-30 percent? Given improvements in overall health, we might be able to decrease that fatality rate to 5-10 percent, but even that is too high for something that is entirely preventable.

I am a believer in questioning – that’s why I’m a scientist. I ask questions. Ask your health care providers to explain those vaccinations. Ask them to reassure you of their safety. Ask them to give you the scientific data to support them. Most providers welcome the opportunity to discuss the importance of vaccines with their patients and they have the answers you seek. They understand our “mama bear” instincts, and they want to protect our kids as much as we do.

Now, I must offer a disclaimer. My life’s work has been in preventing infectious disease. Currently I work for an organization, The Immunization Partnership, which seeks to improve vaccination rates in our community. But, if successful, I’m ultimately out of a job. If we had 80-90 percent coverage, there’d be no need for such an organization. And that would be a good thing.

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14 thoughts on “Skipping Vaccines is Bad Science

  1. Go Cherise! An excellent article on a much needed discussion. We are lucky to have you as a mentor to our students!

  2. I have had dozens of conversations with various highly educated and experienced public health specialists, have read numerous medical articles about vaccination safety and have had many long detailed conversations with family members who are doctors specializing in infectious disease. You are not telling the entire story in this article. One thing you are failing to mention is that public health and personal health are two very different categories. Public health incorporates not just the health of a population, but how that health affects the economy and productivity of a population. For example, when parents have to take time off to care for their sick children or if they become ill themselves, this brings the productivity of a country down. Certain vaccines have been produced to improve public health, but are not necessary or are even detrimental to optimal personal health. Also giving so many vaccinations at once is a public health decision. It isn’t the best choice for personal health, but it is how to get the most people vaccinated. There are real issues with vaccine safety and instead of trying to shut down discussion and hamper necessary change and deny that anything is wrong with the vaccination schedule and vaccine ingredients in this country, it seems that fully investigating the charges and making changes would be a better way to go. The number of vaccinations recommended in this country has gone from 23 doses of 7 vaccines in the 1980’s to 49 doses of 14 vaccines! With this increase in number of vaccines has been a very significant and alarming increase in a number of chronic illnesses in children. In the 1990’s, the rate of autism was 1 in 555. Today that rate is 1 in 50! The rate of childhood asthma has gone from 1 in 27 in 1980 to 1 in 9 today. There are alarming increases in quite a few other childhood chronic illnesses (diabetes and learning disabilities to name a couple). Mercury has now been removed from most vaccines (most likely in part because of public information and pressure), but there are many, many other ridiculous preservatives in vaccines that are injected into the bodies of newborn infants whose immune systems are still developing. While the causes of illnesses such as autism, auto-immune illness, and other chronic conditions are most likely a complex combination of genetics and environment, to pretend that vaccinations play no role in these issues is naive and deceptive. The fact that the Federal Vaccine Injury Compensation Program has paid more than $2.5 Billion to vaccine injured individuals shows that there are real dangers in the current vaccine schedule and makeup.
    You are making an incredibly complex topic far too simple and in doing so, you are being untruthful and unhelpful. If vaccinations were 100% safe, there would be no issue. How about we make vaccine safety our top priority.

    • Thank you for your response and the opportunity to clarify a number of points that can be difficult to make given space limitations.

      As stated in the article, it’s important to keep the conversation open. As patients we have a right to understand our health care .

      Public health and personal health are indeed different. As I explain to my students, a physician is concerned about you, the patient in front of him or her. The epidemiologist is concerned about you, about your family, the people in your home, the people in your workplace, in your school, the people who sat next to you on the bus or the plane, in church, at the Spurs game… We want to know where you got this disease and to whom you may have given it so we can stop its spread.

      How illness affects the economy is hugely important and it’s only recently that public health has begun to take this into account. Eight years ago when we were concerned about pandemic flu, we feared potential illness rates of 30% as had been seen in previous pandemics. Can you imagine how a company would function if 30% of it’s work force was out due to illness? Add in another 10-20% out due to illness of their kids, and the economy grinds to a halt. Companies know that having a healthy workforce means a healthy economy, and have responded with workforce wellness programs that cover a variety of health issues from obesity and diabetes to flu.

      The required or recommended vaccines in place in the US today all protect individuals from the illnesses they cause and they are required due to the local risk. For example, currently the typhoid vaccine is not recommended in the US unless you are traveling to an endemic area and given its route of transmission, it’s not likely to be a huge risk to the community from a returned traveller infected with it, unlike measles. Because diseases such as measles are not so common in the US today, some believe they should no longer be recommended. However, because it is so easily transmitted via aerosol, the risk is still great. Most of the cases of measles in the US this year were linked to travellers to endemic areas, but not all cases were in travelers. They became sick because they came into contact with someone who traveled.

      The number of vaccines has definitely increased over the years because scientists continue to research new vaccines. For example, in 1997, there were 437 cases of Hep A in Bexar County, even though a vaccine had been available since 1995. My daughter was born in 2006, after the vaccine became mandatory. Last year there were 9 cases. The likelihood of her getting the disease now is extremely small. Requiring more vaccines has protected the entire community.

      When a new vaccine is licensed, we can only speculate on the long-term effectiveness. As the years pass, we monitor its effectiveness and make changes as appropriate. When the chicken pox vaccine was introduced, only one dose was recommended. Then we saw breakout cases: chicken pox in vaccinated children, but much more mild cases. My daughter was one of those. So we learned that a second dose would provide better protection.

      I’ll let the experts on autism and asthma discuss the complex reasons for the increased rate in autism and asthma. That doctors are recognizing these disorders earlier is part of the reason for the increased rates. Of course we must always keep in mind “correlation does not equal causation.”

      • Thanks for responding. My biggest issue with discussions around vaccines is that most pro-vaccine individuals reduce anyone who questions the safety of vaccines to uneducated fear-mongers who are out to kill other people’s children! When the reality is that parents who are researching vaccine safety and the staggering number of vaccines given to very young children in this country (the highest number of vaccines in the world!) have most often spent hours and hours doing intensive research and have come up with their own individualized plans for their family (with the help of their Doctor). The CDC admits that only a small fraction of hospitalization, injuries and deaths after vaccination are ever reported (It has been estimated that less than 1% report adverse vaccine reactions!). Denial of or underestimation of risks and issues with vaccines also reduces the large number of people who die or are permanently injured or become chronically ill to “collateral damage.” Our children deserve better. The number of vaccines being combined and given at once is simply NOT SAFE. Most drug company pre-licensure studies do not study new combination vaccines given simultaneously with all the other vaccines licensed and recommended to demonstrate that giving children multiple doses of vaccines at the same time is actually safe.
        Another issue that is often not discussed is the VERY cozy relationship between the agencies that govern vaccine laws and the drug companies that manufacture vaccines (for HUGE profit). For example, Dr. Julie Gerberding, former director of the Centers for Disease Control and Prevention, was named president of Merck and head of their $5 Billion global vaccine business. These conflicts of interest and the $$$ that the vaccine industry spends every year lobbying politicians is not in the best interest of health or truth. It has recently come to light that after years of denying any correlation between autism and vaccines, documents have been released that prove that the CDC was aware that there is a connection. The information released revealed data on over 400,000 infants born between 1991 and 1997, which was analyzed by CDC epidemiologist Thomas Verstraeten, MD, “proves unequivocally that in 2000, CDC officials were informed internally of the very high risk of autism, non-organic sleep disorder and speech disorder associated with Thimerosal exposure.”
        Here are Congressional records from 2003 on this topic. http://www.gpo.gov/fdsys/pkg/CREC-2003-05-21/pdf/CREC-2003-05-21-pt1-PgE1011-3.pdf
        Again, if you want to go after parents who are questioning a very secretive, for-profit, and proven to be unsafe industry (the vaccine pharm companies), you are doing a disservice to the health and well being of humanity.

  3. My 21 year old son Anthony, is a student at University of Nevada, Reno. He and I were just having this discussion the other day. He can’t understand why any parent would not do everything they could, to help keep their children healthy. I will have him read this very informative article Cherise. Thank you for passing on the word for parents to immunize to save lives.

    • Thank you Rosemary! I think that every parent does believe they are protecting their child, but they have incomplete information. As public health professionals, we have to make sure we answer those questions in a way each person can understand. Remember, though, we’re not just talking about young kids. Adolescent and adult vaccinations are so important as well.

  4. Misinformation or Disinformation? Some people spread false information unintentionally and some people spread it intentionally. There is usually a motive for the latter.

  5. It probably isn’t realistic but it would be nice to live in a world in which people self vaccinate or a world where individuals don’t need vaccinations.

    We have 3D Printers now that can print 3D objects from 2D Images so it would be interesting to see a product that develops vaccines for you in your own home. A product that allows people to see the “source code” of the virus and the vaccine that comes with easily understood instructions.

    Just a though.

    • We live in a world where we no longer need a smallpox vaccination because enough people vaccinated against it that it was eradicated worldwide. Kids haven’t had to get a small pox vaccination since the late 1960s. Small pox was eradicated because there were no longer enough susceptible people to become infected and the virus could no longer survive. We can do it with measles and other diseases. #Vaccinate.

      • Yes though there are always pockets somewhere in the world where diseases thrive, where individuals plot, where governments plan, that will always be a threat to the harmony of humanity.

        Giving power – along with knowledge – to the people would surely do some good on this front.

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