From the July 2015 issue

Vaccine Facts vs. Fiction

We've heard the arguments against vaccines, but what are the facts? We break down the arguments to help you better understand vaccines and their importance.

Fever, cough, runny nose. Those symptoms seem common enough in a child. But then there’s the splotchy, red rash that spreads all over his or her body, the diarrhea, ear infection and possible pneumonia. Soon enough you realize that this is no flu. It’s more than that. It’s the measles. And while many people who get the measles improve on their own, some end up disabled or die. This sad fact is especially true for children, whose immune systems often aren’t developed enough to ward off the virus.

At its height, measles infected 3-4 million people each year in the United States, according to the Centers for Disease Control and Prevention. Of those, about 48,000 people were hospitalized, 4,000 suffered from encephalitis (brain swelling) and 400-500 died.

Since the early ’60s, when the measles vaccine program took off, there has been about a 99 percent drop in incidences of measles, according to the CDC.

But that all could change.

2014 was a banner year – not in a good way. With 668 reported cases, measles reached a 20-year high, according to the CDC. This year, the trend is continuing. Through early 2015, the United States saw cases of measles spread across the country. Of the 173 cases reported from Jan. 1 to May 29, 2015, most were attributed to an outbreak at Disneyland in California.

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A majority of those who contracted the disease in that instance were unvaccinated, the Associated Press reported – and while some were too young to receive the measles, mumps and rubella vaccine, others had opted out due to personal reasons.

These recent outbreaks put immunizations and those who aren’t getting vaccinated in the spotlight. And while opposition to vaccines is nothing new (resistance to immunizations and the formation of anti-vaccination groups date back to the 1800s in Europe, The History of Vaccines online resource notes), the reasons for anti-vaccination movements have varied over the years. Here in Michigan, parents are obtaining nonmedical waivers to excuse their children from vaccination, citing everything from religious reasons to personal beliefs and health concerns. In fact, our state has one of the highest waiver rates in the country, says Bob Swanson, director of the immunizations section of the Michigan Department of Health and Human Services.

But with opposition movements come confusion, misinformation – and a lot of concern from public health officials and medical professionals regarding the health of our nation. These vaccine-preventable diseases, such as measles, which have been largely eradicated here due to the success of vaccines, aren’t impossible to contract – and spread. As Swanson puts it, “We are only a plane ride away from any disease.”

To help clear up any confusion or concerns about vaccines and their safety – and to avoid a resurgence of these serious diseases – health experts from southeast Michigan address arguments made against vaccines here.

Are they effective?

Vaccines are highly effective. For most vaccines, the response rate is about 90-95 percent, explains Dr. Bishara Freij, chief of pediatric infectious disease at Beaumont Children’s Hospital in Royal Oak; some are even better. But that’s part of the reason people are foregoing immunizations for their kids today.

“I think the Achilles’ heel of vaccine programs is their success,” Freij says. “And by that, I mean … when diseases disappear, those diseases and their complications begin to recede from people’s immediate memory.”

That is to say, we don’t know just how lucky we have it. It’s easy to see the numerous shots given; we’ve heard negative stories that have been given such weight in the debate about vaccines. “That becomes the focus of the vaccine story, as opposed to how the world has changed after the introduction of the vaccine,” he says.

Vaccines aren’t always 100 percent effective. Some vaccines are less successful than others, such as the pertussis or “whooping cough” vaccine (CDC notes DTaP vaccines are about 80-90 percent effective, and protection wanes over time).

Pertussis is a disease seen in fairly large numbers in Michigan. “We had almost 1,500 cases last year alone,” reports Swanson at the MDHHS. “We’ve had kids die from pertussis. It’s a very, very serious disease.” And with that, he says it’s “certainly better” to have the vaccine than to have no vaccine at all, or there’d be even more illness.

While it’s true building natural immunity to chickenpox or measles through exposure would mean more effective immunity, there’s a reason these vaccines were created.

“Chickenpox used to lead to 10,000 hospitalizations in the U.S. every year, and some deaths,” Freij explains, noting, “children had to suffer from the severely itchy rash for days and were excluded from school for seven to 10 days.” But that’s far from the worst of it.

“For measles, only those who have never seen measles would think that natural immunity is better,” he says. “Measles is a major killer of children in the developing world and can cause severe pneumonia and nervous system infection – both in the immediate phase and as a late complication.”

What’s in vaccines?

Ingredients include a “suspending fluid,” such as fluids containing protein, as well as preservatives and stabilizers to keep the vaccine stable, plus adjuvants or enhancers for effectiveness, among other components, the CDC outlines. The chemical additives, which the CDC emphasizes are found in very small amounts, are there to safeguard the vaccine.

In recent years, there was concern about thimerosal, a preservative containing mercury that was added to vials to prevent bacteria growth. Despite “no convincing evidence of harm caused by the low doses,” the CDC notes, it has been taken out of the recommended pediatric vaccines as of 2001. It is only used in multi-dose vials, Freij explains.

Another concern, Freij notes, is aluminum, which is also an additive used to increase immune system response to the vaccine. Yet it’s something we’re also exposed to in our environment, he says. So to ease any concerns, the FDA did study the risk of aluminum exposure for infants through childhood vaccines, and it found extremely low risk.

Parents concerned about ingredients in vaccines should address their questions with their family’s doctor.

What are side effects?

This might be one of the top worries for a parent debating on whether to vaccinate their child, so here’s the deal: Are there side effects? Yes. But it’s not that cut-and-dried.

“I think it’s not fair to ever say there are no safety concerns to vaccines,” says Swanson. He compares it to any other medication, like aspirin. The risk of reaction is small and, compared to one of these diseases and the associated complications of them, “(the) benefit far outweighs the risk of the vaccine.”

Most of the time, reactions include pain, swelling or redness at the injection site, fever, headache and weakness, Dr. Basim Asmar, chief of infectious disease at Children’s Hospital of Michigan notes. “These are things that are temporary – for maybe a day or two,” he says, adding those reactions can be controlled. That’s compared to life-threatening complications or even death from diseases.

Reactions vary, and they’re outlined for individual vaccines on the CDC’s website for parents to read. The CDC reports that for some vaccines, there’s a very rare risk of a severe allergic reaction to vaccines.

Building on that, what about these severe reactions? There’s a reporting system for those, called the Vaccine Adverse Event Reporting System (VAERS), which you can also look up online and use to report anything your child might experience.

“The severe adverse effects are extremely rare,” Asmar assures, adding these perceived reactions could even be due to something other than vaccines, yet appear related because of the timing. VAERS reiterates: “A report to VAERS generally does not prove that the identified vaccine(s) caused the adverse event described. It only confirms that the reported event occurred sometime after the vaccine was given. No proof that the event was caused by the vaccine is required in order for VAERS to accept the report.”

For example, Freij says instances of developmental delay and infantile spasms appear during infancy, which happens to be during the same time of vaccination. “Then people start correlating these events.”

This can be said for autism, Asmar adds, which is typically diagnosed around 1 1/2-2 years old – also about the time when children receive the measles, mumps and rubella vaccine. And Freij would argue this could be attributed to the expanded definition of autism spectrum disorder and more family doctors making the diagnosis of ASD.

A 1998 investigation suggested a link between the MMR vaccine and autism that caused quite a bit of controversy. That paper by British doctor Andrew Wakefield, published in The Lancet, was later retracted, and several issues were found regarding his research. Studies, including one published in The Journal of the American Medical Association as recently as April 2015, have found no such link, yet skepticism remains.

Are they monitored?

Aside from the monitoring system for adverse reactions, the CDC also researches vaccine safety. The U.S. Food and Drug Administration regulates vaccines. Development of a vaccine can span 10-15 years, with many phases of study and testing before its approved, explains The History of Vaccines, an educational website created by The College of Physicians of Philadelphia, one of the oldest medical societies in the United States.

That’s not to say there haven’t been cases when the risks were enough of a concern. Swanson points to the case of the oral poliovirus vaccine, which, as of 2000, is no longer recommended in the U.S. This decision was made to “eliminate the risk of vaccine-associated paralytic poliomyelitis (VAPP),” the CDC explains. Though this occurred in very few people – about 1 child in 2.4 million, it’s been reported – “that’s how close these vaccines are monitored,” Swanson says.

To emphasize the safety of vaccines, and the small risks associated, Freij likens them to other everyday risks. For instance, when you drive in a car, there is risk of getting into a serious or fatal accident. Or, the risk of picking up a foodborne illness every time we eat.

“There is inherent risk in everything, and it’s just the human condition,” he says.

Still concerned? Talk to your physician.

“Scientifically speaking, these vaccines have had a very good track record and they are very safe,” Asmar says.

Too many vaccines?

There is a recommended schedule of vaccination for children, but Freij says there is a small group of people who will complain there are too many vaccines being given at one time per that schedule – that we’re “overwhelming one’s immune system.”

But that shouldn’t be of concern to parents, Swanson says. “A human body is an amazing work of art, really. If you think about a kid going to school and (being) exposed to how many germs, how many bacteria, how many viruses in a day” – and then look at multiple vaccinations given at a time – “your body knows how to respond to that. That’s nothing compared to what it does in nature.”

Plus, the schedule’s design is based on when the vaccine will provide the maximum benefit. “The science behind it is really done at that age. If you stray from that, then there is a risk of you not being protected at the times you could potentially be most vulnerable,” Swanson says.

In response to this concern, however, parents are delaying vaccines and coming up with alternative schedules for their children – sometimes along with their child’s doctor.

So the question becomes, if it isn’t recommended, why would a physician allow it? Asmar theorizes some doctors might see it as a way to continue caring for the child and ensuring he or she is healthy. Freij refers to it as some taking “the path of least resistance.”

“It’s a very insidious problem,” he says, explaining, “by delaying vaccines, you’re leaving (children) vulnerable at the peak of risk. And that, unfortunately, is kind of being lost on people – including physicians.”

If these diseases are pretty much gone, why vaccinate?

It all comes back to the protection of society as a whole – something called “herd immunity.” There are also children who aren’t able to receive vaccination for medical reasons, like kids born with immune deficiencies, babies too young to be immunized or those with suppressed immune systems like people going through chemotherapy. “They are at high risk of complicated disease if they get it,” Freij adds. And since vaccines aren’t effective for every single person, they’re susceptible, too.

So herd immunity works like this: There is a formula for each disease, establishing what amount of the population needs to be immune to protect the percentage of those who have not developed immunity, Asmar explains. For measles, that rate of immunity needs to be 95 percent, for example.

“It’s concerning to me if parents don’t vaccinate … because it opens up the vulnerable population for outbreaks,” Swanson says.

And since we don’t see diseases like polio in the U.S. anymore, it’s easy to assume the risk is no longer there, but that’s not true. Many diseases still exist outside of the U.S.

“All these infections are still there in nature,” Freij says. “They will re-emerge as soon as you have vulnerable populations.”

Long-term outlook

What it comes down to is this: Asmar says if we stop vaccinating, “Some of these diseases will come back – and they will come back with a vengeance.”

And as a community, it’s our job to protect the vulnerable. “It’s part of what we have to do for the better good,” Freij says. “We’re all connected one way or the other.”

Michigan has some counties with waiver rates as high as 20.7 percent as of January 2015, so the state has taken steps to educate the community about immunizations. As of January 2015, to obtain a nonmedical waiver for a child who attends school or a licensed child care or preschool facility, parents have to go through an education session with their county health department. This allows a conversation about their concerns and the facts regarding the benefits of vaccination and the risks of the diseases they prevent.

Still, Michigan parents are able to obtain nonmedical waivers for religious and philosophical reasons following the session. Currently, Mississippi and West Virginia do not allow religious or philosophical exemptions for school-mandated vaccines and, as of early June 2015, California was working to enact these stricter laws, too, AP reports.

Freij emphasizes that these physicians have studied for years and are sincerely trying to help families and the population at large. He tells parents he had his son immunized with every vaccine that was available. “I see these problems and I didn’t want him to have any of them. (I) cannot recommend it enough.”

Anyone with concerns about vaccinations should consult their health care provider or they can call their local health department.

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