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Are vaccines
safe? is a question many parents ask. The purpose of this
section is to help you find medically and scientifically accurate
information about vaccines and immunization to help you answer some
of your questions. A great deal of information about vaccines is
available today in print, through the media, and on the Internet.
It is important for both patients and providers to have access to
current research and be able to read about issues that affect health.
However, not all the information you will find is accurate, and
some statements may be misleading when taken out of context.
The disappearance
of many vaccine-preventable childhood diseases has led some parents
to question whether immunizations are still needed. In addition,
some parents are concerned that vaccines may be the cause of conditions
such as autism. These concerns have led
some parents to delay or withhold vaccines for their children.
Here are some
answers to questions asked by San Diego families about vaccines,
with links to nationally respected immunization resources should
you wish to look further. (You can also look in the Frequently
Asked Questions section for additional information.)
Q:
Why immunize?
A: Immunization provides protection against the risk of dangerous
diseases. The protection provided by vaccines falls into three categories:
- Protection
against common infections, such as chickenpox and whooping cough
- Protection
against infections that are now at low levels but could easily
reemerge. These include measles, mumps, rubella and Hib.
- To prevent
infections that are still common in other parts of the world,
like polio and diphtheria
(Atkinson, W. et al. Epidemiology and Prevention of Vaccine-Preventable
Diseases, 6th Edition, Centers for Disease Control and Prevention,
USDHHS, 2000)
Immunization has
reduced most vaccine-preventable diseases to all-time lows in the
U.S., but this is not true for all parts of the world. Many of the
diseases that we never see are still common in other countries, and
are only a plane ride away from our community and our families. Widespread
immunization is the wall that stands between theses diseases and their
rapid spread through our population.
We immunize
to protect our children and ourselves. While it may seem that the
risk of getting any of these diseases is small, they still exist,
and can infect anyone who is not protected. San Diego is one of
the busiest ports of entry into the United States, with many millions
of travelers and new residents entering the county every year. It
attracts tourists, immigrants, students and members of the military
from every corner of the globe, and anyone might unknowingly bring
these diseases to a shopping center, school or neighborhood near
you.
We also immunize
to protect those around us. There are some people who cannot be
vaccinated because of severe allergies to vaccine components or
other physical limitations, and a small percentage of individuals
do not respond to vaccines (they don't work for these people). These
people are at risk, and the only hope they have for protection is
that enough people around them are immune through vaccination and
can't catch and pass on the disease to them. Just as no one of us
can drive safely on the freeways unless everyone follows the traffic
laws, the protection of individual children and families from vaccine
preventable diseases depends on a successful immunization program
for the whole community.
For more information,
visit the Vaccine Education
Center at The Children's Hospital of Philadelphia at http://www.vaccine.chop.edu.
Another helpful source is the Immunization section of http://kidshealth.org.
Q:
Is it safer to be naturally infected than to be immunized?
A: No! Diseases cause suffering, and in some cases permanent
disability and death. Vaccines allow a person to be protected from
the disease without risking the serious adverse effects of that
illness. What is "natural" about a child's suffering?
Immunity from
a disease may follow a single episode of infection, although this
is not always true. Immunity acquired through vaccines in some cases
requires several doses. However, the cost for disease-acquired protection
can be high. Complications of infection with vaccine -preventable
diseases can include pneumonia from chickenpox or pneumococcus,
mental retardation from Hib, severe birth defects from rubella,
liver cancer from hepatitis B virus, or brain damage or death from
measles.
For more information
on the complications and comparative risks of vaccine preventable
diseases, we recommend that you link to one of these web sites for
the latest research:
Many parents try
to compare the risk of immunizations to the risk of disease. They
say that "even one case" of adverse reaction to a vaccine
is too many. To look at the real risk, we must compare the numbers.
The risk of dying of complications from the measles is 1 in 1,000
cases. The risk of suffering a severe adverse reaction is 1 in 1,000,000.
Which risk is greater for your child?
Immunization
is one of the greatest achievements of modern medicine. It has spared
millions of people the effects of devastating diseases, and saves
the lives of thousands each year in the United States alone. Widespread
immunization is one of the most important ways to protect people
of all ages against serious infectious diseases and their consequences
and has nearly eliminated many diseases. Measles, diphtheria and
pertussis were once responsible for millions of infections and thousands
of disabilities and deaths each year. We now see very few cases
of measles, almost no cases of diphtheria, and the number of pertussis
cases is only a small percentage of the 175,000 cases per year reported
in the 1940's.
One goal of
immunization is to eliminate disease. That has been accomplished
in the case of smallpox, which was responsible for 300 million deaths,
more than any other disease in history. Smallpox has been eradicated
worldwide through immunization. Before the end of the year 2015,
it is hoped that polio and measles will also be eliminated.
Just a few statistics
on the impact of immunizations:
Haemophilus
Influenzae type b (Hib): In the U.S. before 1985, Hib caused
serious infections in 20,000 children a year, including meningitis
(12,000 cases) and pneumonia (7,500 cases). Due in large part to
high Hib vaccination rates, in San Diego County there was only 1
case of Hib in 2001 and no cases in 2002.
Because of the
success of the Hib vaccine in reducing the incidence of meningitis
in children under 5, the new leading cause of bacterial meningitis
is the streptococcal pneumococcus bacteria. Fortunately, we now
have the pneumococcal vaccine (PCV) to protect our infants and toddlers
from this devastating disease.
Rubella (German
measles): In the 1964-1965 U.S. epidemic, there were 12.5 million
cases of rubella (German measles). Of the 20,000 infants born with
congenital rubella syndrome during, and immediately following the
epidemic, 11,600 were deaf; 3,580 were blind; and 1,800 were mentally
retarded as a result of the infection. There has been 1 reported rubella
case each year since 1999 in San Diego County.
Rubeola (Measles):
Before 1963, when the first measles vaccine was licensed, more than
3 million cases of measles and 500 deaths from measles were reported
every year in the U.S. More than 9 out of 10 children had measles
disease by age 15. After the vaccine was introduced, and school immunization
requirements were implemented, disease rates went down, reaching a
low of 3 cases in San Diego County in 1983. The disease made a comeback
in 1989-91 both nationally and locally, due to low immunization rates
in preschool aged children and infants. There were 985 reported cases
in San Diego during 1990, and 3 children died.
Today, largely due to air travel, we are still at risk for measles due to outbreaks in other countries. In 2003, a young adult became infected with the measles virus while in Europe then flew to San Francisco, potentially infecting individuals on the airplane and contacts in San Francisco. 2008 saw the first outbreak of measles in San Diego since 1991. Twelve cases were reported and some 70 people were quarantined at their homes to interrupt the spread of the disease.
Polio: In
1952, polio paralyzed more than 21,000 people in the U.S. The last
case of polio in the Western hemisphere was reported in 1979.
Pertussis
(Whooping Cough): In the early 1940s, the national average was 175,000 cases of pertussis (whooping cough) each year, resulting in the deaths of 8,000 children annually. Although much less common, this disease continues to be a problem in San Diego County. In 2003, we had 101 reported cases locally, resulting in 145 days of hospitalization which cost approximately $362,500. Also, in 2005, 371 cases of whooping cough were reported in the County, the highest number in many years.
Diphtheria:
In the 1920s, there were 100,000 to 200,000 cases of diphtheria each year in the U.S. 13,000 people died from the disease. We have not seen a case in San Diego County for over 15 years, but we remain at risk because of travel to the former Soviet Union and many other countries around the world where this disease still exists.
A case of diphtheria was reported in the United States in 2003. After returning to Pennsylvania from Haiti, a 63-year-old man visited a local emergency department complaining of a sore throat and difficulty swallowing. He was treated and released. On the fourth day of illness he returned to emergency with chills, difficulty swallowing and breathing, nausea and vomiting. He was admitted to intensive care where he was eventually diagnosed with diphtheria. After several days in the hospital he developed cardiac complications and died. He had reported never being vaccinated against diphtheria.
Due to the current high levels of immunization in the United States, most of these diseases have been cut to near zero. Thanks to immunization, smallpox has been eradicated, polio has been eliminated, and only 2 cases of diphtheria, 116 cases of measles and 3 cases of congenital rubella syndrome were reported for the whole nation in 2001.
Q:
Do vaccines overload the immune system in infants or children?
A: Many parents have a hard time watching their child get even
one shot, and it can be even harder to watch their healthy baby
getting multiple injections. As recently as 15 years ago children
were given five shots by the time they were 2 years old, and no
more than two shots at a single visit. Now children may receive
as many as 26 shots by the time they are 2 years old and as many
as six or seven shots in a single visit! It is natural for parents
to wonder whether children can handle so many shots at the same
time and whether vaccines can overwhelm the immune system.
Infants and
young children daily meet and manage many challenges to their immune
system all at the same time. Although the mother's womb is free
from bacteria and viruses, once born, every baby immediately faces
a host of different threats to the immune system. From birth, thousands
of different bacteria start to live on surface of the baby's intestines.
By quickly making an immune response to these bacteria, babies keep
the bacteria from invading their bloodstream and causing serious
disease.
Other challenges
include the food they eat, and the things and people they touch.
In fact, babies can respond to millions of different viruses and
bacteria because they have billions of immunologic cells circulating
in their bodies. So the vaccines given in the first two years of
life are only a tiny part of what every infant's immune system successfully
meets and overcomes every day.
Even though
we know that the shots our babies are being given are important,
we hate to see them cry. For useful tips on how to comfort your
baby during and after immunizations, see Be
There for Your Child During Shots. You can also ask your doctor
or health care provider for a copy when your child is immunized.
Q: Does the MMR vaccine cause autism?
A:Many carefully performed studies say no. For the latest information on this topic, please see the sources listed below:
American Academy of Pediatrics (AAP)’s web pages with information about vaccines and autism:
http://www.aap.org/new/autisminfomain.html
The federal Centers for Disease Control and Prevention has a wealth of information on vaccine safety:
http://www.cdc.gov/vaccinesafety/concerns/
Also, please see the Statement on Vaccines and Autism From The Public Health Officer
Q:
How can I sort out the conflicting information about vaccines?
How do I know if the information about vaccines that I find on
the Internet is accurate?
A:With the large amount of information on the internet now, it can be confusing to determine what is accurate and valid information. The National Network for Immunization Information has a good answer to this question. You can find it here:
http://www.immunizationinfo.org/parents/evaluatingWeb.cfm
Also, the Centers for Disease Control and Prevent has more information here:
http://www.cdc.gov/vaccines/vac-gen/evalwebs.htm
Most importantly, the health information that you find on the web should be discussed with your doctor or health professional. Information from the web should add to rather than replace the information or advice given to you by your doctor.
Q:
Is there a local resource to contact for more information?
A: Our Immunization Program Public Health Nurses are available
to help you with all your immunization questions and concerns. Please
call the Immunization Program during normal business hours at (619)
692-8661 and ask to speak to a Public Health Nurse.
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