Monday, September 23, 2013

Vaccine Follow Up Questions

The previous post on vaccines generated some important questions, which I will do my best to address below:

Why does the USA vaccinate more than other western countries?
For example, some countries don't include Varicella (chicken pox), Rotavirus and HepB, but America does.

Varicella –
For many, especially children, chicken pox is very mild. However, if someone has not had chicken pox as a child and contracts it as an adult they can suffer more seriously, such as pneumonia and encephalitis. The virus can also negatively affect pregnant women and immuno-compromised people (people on chemotherapy, children with leukemia, etc.)1,2. Thus, it’s somewhat straightforward why we don’t want this virus around. To that end it seems like the US takes a holistic approach and tries to protect everyone by immunizing, well, everyone. From what I have read, countries that don’t immunize all children for varicella try to hedge their bets by guessing who is most at risk (healthcare workers, family members of compromised patients) and hoping they can catch everyone important1. In my opinion, the problem with a non-holistic approach is that it requires extensive effort to guess who may or may not need the vaccine and thereby puts those who are compromised at unnecessary risk.

Hepatitis B-
This vaccine follows similar logic to that of Varicella. That is, it is much easier to catch all children when they are young than to pick out people who may be at risk for any number of reasons later on. And this is of course the case for many, many things (such as HepA). But in the case of HepB, I think the reason to be so proactive is that the disease can be severely debilitating, including fatal, and it's not worth playing the odds. Hep-B is spread through blood contact, which can definitely, and often does, mean sex. But it can also mean the scabs and boo-boos of child life3,2.

Rotavirus -
Rotavirus is extremely contagious. As in, before the US began vaccinating, almost all children would contract it4. The virus leads to severe diarrhea, which in all people but especially infants  can lead to dehydration and worse. It is so contagious that a child is almost guaranteed to contract it if not vaccinated and the severity can range from minor to fatal4.

There are also vaccines that are only conditionally recommended, even in America. For example, HepA is only recommended for high risk people. I only received this vaccination when I went abroad as an adult

What about negative reactions to vaccinations and accidents or shady work in pharmaceutical safety tests?
Unfortunately, there is a chance for a negative reaction to almost all decisions we make. Think of the diets we readily give children. There are some very severe allergies out there and as far as I know, the main way we find out about them is when a severe reaction happens and we respond. Some vaccines have no reported negative effects, which is pretty crazy (in a good job science! way). Others do have reported serious allergic reactions, but those reactions are so rare (less than 1 in a million) that it’s actually hard to tell if it was the vaccine that caused it or not6. As for the credibility of the CDC and FDA and their regulation of drugs… that’s a tough one. There have obviously been tragic mistakes. But for the vaccine schedule of children, that issue isn’t as relevant. These vaccines have been tested and used for a long time and the CDC does extensive and constant monitoring of the safety. They actually monitor it so closely that even the suggestion of danger (not proof) has caused them to temporarily withdraw a vaccine and reconfirm its safety before further administration. (In fact, this [in the opinion of many as well as mine] was a disastrous and destructive move. An unproven claim rippled through the vaccine community, scared enough people to get the vaccine revoked only to find out it was perfectly safe. Now, the public is terrified of that vaccine, MMR, and all vaccines. That's the autism-vaccine story).


How can we feel safe when we don't know about long term side effects of the vaccine and its chemical components? 
What are we going to know in the future? …that is a huge question. That’s a question that plagues all of the medical world. What are we doing now that we are going to regret later, or look back on and say "What idiotic logic made us think that was smart!?" Who knows. We can try to guess but really, who knows? What we do know is that we are living longer with a better quality of life thanks to vaccines. In other words, whatever harm vaccines may do to 80 year olds is probably not as bad as that 80 year old dying at the age of 7 from pneumonia… which is why we as a world have chosen to vaccinate and take other “chances” in medicine. 

This answer may seem unfortunate and unsatisfactory with those struggling deeply with the idea. It may seem harsh and insensitive. But it is simply truth put bluntly. The experiment of life is ongoing. What is good? What is bad? Maybe too much espresso will give us cancer. Maybe too much time at a computer will, too. We just don't know. It's up to the individual to weigh every single one of those choices against the alternative. Should you give up coffee? Not so bad. Give up your IT job? It's hitting closer to home. Risk your child getting the measles, rotavirus or polio? The thing about this last question, though, is that we have actually done the experiments! Vaccinated children DON'T get autism, and they are also microscopically at risk for any other side effects. Not immunizing is the exceedingly more risky option.

The Amish community is known for not vaccinating, do they have higher rates of childhood illness because of this? 
I actually had not previously heard this about the Amish, but a simple google search revealed that it seems to be commonly known that Amish under-vaccinate. However, after a little more aggressive digging  I came up with two responses. 
1. A study in Illinois found that Amish vaccinate more than we thought. The rationale for why this was originally misrepresented is that Amish don’t take part in internet or phone surveys7.

2. Yes, under vaccinated communities have an increased rate of disease. In 2009, a study showed that “Children with exemptions from school immunization requirements (a measure of vaccine refusal) are at increased risk for measles and pertussis and can infect others who are too young to be vaccinated, cannot be vaccinated for medical reasons, or were vaccinated but did not have a sufficient immunologic response.”8 Seperately, it was shown this year that in counties in NY where fewer people were vaccinated there were increased cases of pertussis9.




 2. The varicella, hep b, hep a and rotavirus chapters of this government publication
3. http://www.cdc.gov/hepatitis/B/index.htm
4. http://www.cdc.gov/rotavirus/index.html
5. http://www.cdc.gov/vaccines/vpd-vac/hepa/default.htm#disease

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