Page 26 - Sonoma County Gazette June 2019

Vaccine Controversies
There have been 40 measles cases confirmed in California, and over 700 in the US since January 1, yet it was declared eradicated in the US in 2000. A combination of prevalent virus in other countries, international travellers bringing it back home, and the illness getting a foothold in areas of lower vaccination rates have led to the current high level of cases in the US.
Last month, we looked at the epidemiology, and this month we will visit some controversies around decisions to not vaccinate. This is a very disputed topic, and much of the medical community strongly disagrees with the perspective of non-vaccinating parents. I contend that reasonable discussions can be had, since both sides have useful perspectives.
Measles Facts:
● Measles is very contagious,
● Death, deafness, and neurologic sequelae are known complications.
● 97% of vaccinated people are protected from getting infected.
● “Herd Immunity” is obtained when 95% of the population is immune,
● In California, proof of vaccination is necessary to enter Kindergarten and
7th grade, unless there is a ‘medical exemption’ signed by a doctor. ● To check on vaccination rates in local schools: https://www.shotsforschool.org/k-12/how-doing/
Low Vaccination Rates:
Clearly, some childhood illnesses have been markedly decreased due to vaccines. In my career, I have seen a significant decline in serious infectious illness in kids, and a decrease in permanent complications like deafness and developmental delay due to meningitis.
At the same time, the vaccination schedule has gotten complicated. In the 1980s, there were 7 vaccines available, with some combinations, so kids got a total of 5 shots by the time they were 2 years old. Due to the rapid development of vaccine technology, children now receive as many as 27 shots by 2 years of age and up to five shots in a single visit.
Prevention of severe disease like polio or Haemophilus influenzae meningitis is life-changing for the kids that would have been affected by
it. Surprisingly, though, Hepatitis B vaccine is usually given at birth before leaving the hospital, even though there is little risk of an infant getting Hep B. Similarly, the argument for the Chickenpox vaccine was primarily made on economic grounds-- preventing lost work time for parents.
There are very few medically recognized contraindications to vaccination. Concerns about autism caused by the vaccine have been heavily publicized, but major reputable studies have been unable to prove any connection. At this point, there is no mercury or thimerosal in the MMR (Measles) vaccine.
It seems clear that most parents make choices for their children with a sharp eye on protecting their health. It isn’t hard to imagine that parents who focus on natural lifestyles and organic foods would look skeptically at giving 27 shots to their baby by two years old, especially for an illness they are unlikely to contact. Polio has been eradicated in the Western Hemisphere, and measles has been pretty scarce in recent years.
Yet the situation can change. In the case of measles, if the child never comes into contact with the virus, there is no need for vaccine, and any vaccine
risk (no matter how small) is greater than risk of the disease. Yet, the current risk of virus exposure is much higher than in other years, and strong public health measures are being taken so that unvaccinated kids that may have been exposed are being forced to stay out of public areas until they can either prove immunity or until contagion has passed. Close to 1000 college students in Southern California were quarantined last month.
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it may be worthwhile for reluctant parents to revisit the issue, since their child could get sick or be quarantined if measles breaks out in the area. It also might be an important contribution to protect the health of some of the more vulnerable community members. It is not too late to vaccinate now.
Conclusions: In my experience, parents who opt not to vaccinate are doing so with the intention of protecting the health of their children. Not all vaccines are the same in terms of the severity of the illness they are preventing, yet measles can be serious. In the current climate of concern about measles,