vaccinesareawesome

About 2 years ago, friends of mine (who were expecting their first child) were on the fence about vaccinating their child and wondered if I (as a allergist cramming for his allergy and immunology boards) had an opinion about vaccines.  Needless to say, I kinda went nuts and wrote this insanely long email back to them.  In light of the measles outbreak that we’re seeing now (currently affecting infants in the community I treat) I thought I’d repost the thoughts and personal experiences I had with vaccinations back in 2013.

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As a board certified allergist and immunologist, I’m a very big fan of vaccinations. My wife (another allergist/immunologist) and I know that when we have kids, we’re gonna be giving him/her every immunization exactly on schedule. Here are some reasons why (in my opinion…. based on what I know of the science as well as my personal experience dealing with critically ill young children)

1) Vaccines are fucking awesome. In a generation, vaccinations have improved both the quality and quantity of life of kids around the world. And I’m not just talking like compared to 100 years ago. In my Pediatrics training, my attending Pediatricians (who were in training maybe 20 years before me) would tell horror stories about all the kids with H. Influenzae meningitis that would overload the wards every year. Kids used to die from it all the time- in the 70’s and 80s! In the 20-30 years since the vaccine has been available, H. Influenzae has plummeted. (there were 20,000 cases in 1984 and 25 cases in 2009). Even though it’s still all over our textbooks, I’ve never seen H. Inflenzae in my life. That’s 100% due to the H. Influenza component of the vaccines babies get at 2, 4 and 6 months of age. There were 200,000 cases per year of Diptheria in 1920, 0 in 2009; 900,000 cases of measles in 1941, 61 in 2009. Rates of hepatitis B went from 26,000 per year in 1985 to 3000 in 2009. These are all potentially deadly diseases that have been taken off the table as potential reasons a child doesn’t make it to adulthood. That’s another important point, many of these diseases are not deadly to adults but can very much take the life of an infant and young child.

But things are still improving. Since the mid-1990s, kids have been getting vaccination to Varicella. Our generation may be the last to have ever gotten the Chicken pox. This also means that as adults, people may not get Shingles anymore….like ever. Immunizations also work so much more elegantly than antibiotics or really any other medication. We’re not blasting the body with the blunt force of antimicrobial chemicals. We are literally teaching the immune system to create their own natural protective response to organisms. Vaccines are fucking amazing.

2) Vaccines are Safe. Vaccinations are infinitely safer than any medication that would be needed to treat a vaccine-preventable illness. As you may know, the autism link to MMR was 100% falsified and retracted. The doctor behind that study was also found to have been paid like $600,000 by a law firm that planned to sue vaccine manufacturers. He had his medical license revoked and a ton of studies of vaccine safety have failed to show ANY link to autism (http://www.jpeds.com/content/JPEDSDeStefano) . So the autism link at this point is pretty clearly a 100% bogus claim.

The incidence of autism is increasing in recent decades likely because we have a better way to diagnose it and we start to look for it earlier. Pediatricians now have standardized questionnaires they conduct with parents starting at 15-18 months of age. Autism is now more frequently diagnosed by Pediatricians around 18-24 months of age. That also happens to be the age that kids make major leaps in social development and language expression. That coincidentally happens to be when the MMR vaccination is given. The data clearly shows that MMR doesn’t cause autism, and what’s more likely is that we have become more vigilant at discovering it during a time when those social changes are supposed to take place. What’s most likely happening is that a child is born with autism via a genetic predisposition. But since autism is primarily discovered by abnormalities in social and verbal development, a 2 month old with autism would be very hard to distinguish from a 2 month old without autism (because neither would have reached many milestones in terms of social and verbal skills). But when those natural social and language milestones are made by kids without autism at 18-24 months of age, the lack of progress in kids with autism is more acutely noted.

In terms of safety of other vaccines, they are all overwhelmingly safe. The only adverse reactions I’ve ever seen were to kids with food allergies having allergic reactions to the ORGANIC components of vaccines (like egg protein). And even then, it’s nothing that causes any permanent changes. The benefits FAR outweigh the risks. I’ve never seen any adverse reactions to the preservative components (such as thimerosal). However, the majority of vaccinations can come in thimerosal-free formulations. Additionally, the preservatives are necessary to keep the vaccinations safe and stable.

I also don’t recommend splitting the dose, because it’s not doing anything to benefit the child. All it does is give the parents some comfort that they are “sparing “ their baby of unnecessary pain. That’s not true because splitting the dose is just going to lead to more pokes. Additionally, delaying the does simply delays the time that a child will be protected from potentially life threatening illnesses. An infant’s immune system is robust and is very much able to handle multiple vaccinations (or combination vaccines) at once (they are being bombarded with exponentially more immune stimulating factors every day from food, the environment). In my experience, kids recover from the shots fast, they stop crying within 10-20 seconds. Sometimes there can be some swelling at the injection site and sometimes a low-grade fever in the 24 hours after the injection. But these are also completely benign and tell you the vaccine is WORKING (it does not reflect a side-effect or infection). Swelling and fever simply tell you that the baby’s T-Cells have gone to the site of vaccination and are learning to develop a memory to the antigen that they have been exposed to. In this vaccine the antigen is just protein components of the microbe (meaning that it’s not the actual living bug that could cause an infection). However, now that the immune system remembers this protein combination, when the ACTUAL (potentially deadly) microbe enters the body, an army of TCell and BCells are ready and waiting to destroy the hell out of the invader before you even know you’re sick. And this memory can last a lifetime. Simply amazing. And safe.

3) Vaccines are also for the greater good of the community. Herd immunity is an amazing thing. Beyond the benefits to your baby alone, the immunization also protects the community as a whole. And in that sense, vaccinations are also a very altruistic pursuit. Here’s an example. Pertussis (or Whooping Cough) is a super annoying illness that can lead to a persistent cough for months. It can get people really sick, but resolves with a course of antibiotics pretty easily. In addition to the infant immunization, we advise that people get a pertussis vaccination booster as an adult. I had a patient last week who was an adult who didn’t want to get the pertussis vaccination. She gets a large swelling with shots and didn’t want to endure the pain of the shot and swelling. Now if she did get whooping cough, she’d be fine after a course of antibiotics, no big deal. But here’s the rub. Infants (even while their getting immunized to pertussis in those early immunizations) do not develop a complete immunity until they are older than 1 year of age. So ALL infants are susceptible to pertussis. And the bigger issue is that while whooping cough is an annoying thing for adults, it can be a VERY lethal disease in infants. My patient just happened to be in a field of work where she was exposed to young children with special health care needs every day. I had to explain to her that getting vaccinations wasn’t just for her, but for the good of the countless vulnerable kids she could infect with pertussis.

This has been documented time and time again as parents are not immunizing or delaying immunizations with their kids. There are outbreaks of measles, mumps, whooping cough in Minnesota, Wisconsin and more recently, a measles outbreak at a mega-church where there the pastor had concerns regarding autism, immunizations, bundling immunizations and “doubting that God would keep you healthy rather than vaccines” (http://www.npr.org/2013/09/01/217746942/texas-megachurch-at-center-of-measles-outbreak).

So while it is the parent’s choice to not immunize their children, they are putting the health of other children at risk who’ve had no consent in that decision Often times parents don’t realize that these decisions affect more than just their own children.

This is all very concerning, because the less we immunize our kids, the more the herd protection wanes. Just as easily as many disease were essentially eradicated in a generation, they can come back.

Whoah. Sorry I went on a rant there. I think it’s a combination of the patients I’ve been seeing (the sick one’s I’ve seen) and all the immunology I’ve studied. I’d say all the CDC recommended vaccines are essential. I think the dosing schedule is safe and the most effective. I’d say all the doctors I’ve worked with have come across this with the best of intentions. As physicians there is no financial incentive to immunize kids. If anything, children sick with vaccine-preventable illness wrack up insanely high hospital bills. So I would say monetary gain does not factor in doctors’ (and definitely not my) recommendations.

So to summarize…. 1) Vaccines are fucking awesome 2) They are totally safe 3) It’s also for the greater good of the community

yer pal,

Alex