Why I vaccinate my kids

Being a new parent is exhausting. All of a sudden, you’re out of the hospital and on your own with this amazing, tiny human, and you alone are responsible for her care. You’re given reams of paperwork about feeding and sleeping, developmental milestones, red flags to look out for. You’re inundated with information you barely have time to look at. Mom is trying to heal from childbirth while barely sleeping, while her partner is trying to pick up the slack and pitch in as much as possible. You both fumble with the car seat, thinking that NASA must have equipment that’s easier to figure out. You obsessively check your sleeping baby to make sure she’s still breathing. You worry about every sneeze and try to decipher her cries. Is the diaper too tight? Is this acne normal? What do I do about her poor dandruffy head?

Do I vaccinate?

vaccineWilliam receiving the first of  his 2-month vaccinations

I know it can be scary. You might have heard from friends or relatives, or read on the internet, that vaccines can harm your baby. You may be concerned about autism, or think that “natural immunity” is better than that which develops from injections. You may think that the diseases she’s being vaccinated against “aren’t all that bad,” or that kids today receive too many vaccines. You might feel that your physician is “bought out” by “big Pharma” and that your health care providers are writing off your concerns.

I know you just want to do what’s best for your child. I feel you. I’m the parent of a teenager, a tween, and a 2-month old. Here is why I vaccinate my children.

William vax 2William receiving his vaccinations

I’ve spent almost 20 years of my life studying infectious diseases up-close and personal, not from random websites on Google. I’ve worked with viruses and bacteria in the lab. I respect what germs are capable of. I worry about vaccine-preventable diseases coming back because of low levels of herd immunity. I cry over stories of babies lost to pertussis and other vaccine-preventable diseases. As I’ve noted before, chicken pox has played a role in the deaths of two family members, so I don’t view that as just a “harmless childhood disease.” Vaccines have eradicated or severely reduced many of the deadliest diseases from the past: smallpox, polio, measles, diptheria.

But that’s not the only reason I vaccinate. I vaccinate because I’m all too aware of the nasty diseases out there that still don’t have an effective vaccine. My current work focuses on a germ called methicillin-resistant Staphylococcus aureus (“MRSA”), a “superbug” which kills about 11,000 people every year in the United States. We have no vaccine. I previously worked on two different types of Streptococcus: group A and group B. Group B is mainly a problem for babies, and kills about 2,000 of them every year. It leaves many others with permanent brain damage after infection. We have no vaccine. Group A kills about 1,500 people each year in the U.S. and can cause nasty (and deadly) infections like necrotizing fasciitis (the “flesh-eating disease”). We  have no vaccine. These are all despite the fact that we still have antibiotics to treat most of these infections (though untreatable infections are increasing). Infectious diseases still injure and kill, despite our nutritional status, despite appropriate vitamin D levels, despite sanitation improvements, despite breastfeeding, despite handwashing, despite everything we do to keep our kids healthy. This is why protection via vaccination is so important for the diseases where it’s available. If vaccines were available for the diseases I listed above, I’d have my kids get them in a heartbeat.

w after vax 1William with daddy, right after finishing his vaccinations

I’ve done my best to keep my kids healthy and safe. I nag about bicycle helmets and make sure they’re getting exercise. I make them eat vegetables. I don’t move the car until everyone is buckled up. My older kids were in booster seats for what felt like forever, as both were on the small size for their age. Vaccinations are just one more part of this arsenal. I’m well versed in the safety data and know that most vaccine side effects are minimal (fever, soreness at injection site). They don’t cause autism, or SIDS, or any of the other claims made by dubious sites such as Natural News or Mercola. They do save lives and prevent disease by training the body to recognize and fight germs.

My youngest recently went in for his 2-month shots. He cried a bit when he received them, but not any worse than he does when he needs to be burped, changed, or held. He slept a little extra that evening, but was back on his normal schedule the next day. At his visit, he received the oral rotavirus vaccine; his second Hepatitis B shot; his pneumococcal vaccination; and the combination shot including diptheria, pertussis, tetanus, polio, and Haemophilus influenzae (DTaP/polio/Hib). Each one I see as a small measure to support his health and safety, as well as my own peace of mind, knowing that I did what I could to protect him from infections that used to kill thousands of children every year. Some still do when vaccination isn’t available or accepted–measles killed over 120,000 people in 2012, most of them young children who hadn’t been vaccinated.

W after vax 3William at home after his vaccinations

We all try to do the best by our children. As a scientist who’s studied infectious diseases, vaccination is a no-brainer for me, and I worry for the children out there who are left undefended against these infections because of misinformation and wrongly-placed fears. I know these parents are trying to do right by their kids, but infectious diseases don’t recognize good intentions. As I sit here with my baby breathing softly beside me, I am thankful for those who came before me and dedicated their lives to protecting children like him, and grateful that he will never have to suffer from infections that were the scourge of earlier generations.

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Student guest post: The Fallacious Fad of Foregoing Vaccinations

It’s time for this year’s second installment of student guest posts for my class on infectious causes of chronic disease. First one this year is by Dana Lowry.

Humans have a long history of illness and death from infectious diseases. It wasn’t until the 1790s that we had a solution. Edward Jenner recognized that milkmaids never contracted smallpox but suffered from a more mild disease, cowpox. Jenner took pus from a cowpox lesion on a milkmaid’s hand and placed it in an incision he made in an eight year-old boy’s arm. He then exposed the boy to smallpox; the boy didn’t contract the disease, proving he was immune. Jenner experimented on several other children, including his own 11-month old son, and his theory of passing on immunity proved to be successful. The Latin term for cow is vacca, which is where Jenner coined the term “vaccine”. Jenner’s discovery eventually led to the eradication of smallpox from the U.S. in 1949 and from the world in 1979. For over a century, vaccines were limited to preventing smallpox but as we know today, vaccines prevent a large number of diseases.

Although many developing countries still suffer from the burden of preventable infectious diseases, the U.S. has greatly increased the life expectancy and quality of life through the use of vaccines. In the 1940s, the U.S. recommended vaccines for diphtheria, pertussis and tetanus; polio was added in the 1950s. In the 1970s, measles, mumps and rubella (MMR) were added to list. Today in the U.S., immunizations are recommended for 17 vaccine-preventable diseases during one’s lifetime and more are available for individuals traveling outside of the U.S. Many of these vaccinations are combined so they can prevent multiple diseases from one series of immunizations. The increase in life expectancy in the 20th century is largely attributable to vaccines. For each birth cohort vaccinated, 33,000 lives are saved, 14 million cases of disease are prevented, healthcare costs are reduced by $9.9 billion and $33.4 billion is saved in indirect costs. The Bill Gates Foundation believes that vaccines are one of the most cost-effective investments in global health, saving about 2.5 million lives each year. One child dies every 20 seconds from vaccine-preventable diseases while tens of thousands of other children suffer from severe illnesses and permanently disabling diseases.

Despite the facts, less and less parents are choosing to vaccinate their children today because of fears that vaccines are unsafe. Much of the controversy started with Dr. Andrew Wakefield, a former British surgeon and medical researcher. Wakefield published a paper in 1998 linking the MMR vaccine to autism and bowel disease. Wakefield’s entire study was found to be fraudulent and the infamous paper was retracted in 2010. But, what got more attention than a retracted science paper was Jenny McCarthy sharing her personal life story of how her son got autism from a vaccine on the Oprah Show. Unfortunately, more moms keep up-to-date with Oprah and popular news rather than science and still do not know the truth behind Wakefield’s falsified study; therefore, the autism myth continues.

Furthermore, parents argue “herd immunity”. If your children are effectively vaccinated then why would I have to worry about mine? First, many vaccine-preventable diseases still exist in other countries and can easily be brought into our country; second, some individuals do not build immunity to the disease even after vaccination. The more and more parents that opt out of vaccinations, the less protection their children have from the rest of the “herd”. Additionally, parents argue that their children should contract diseases “naturally” through the environment to build immunity. Parents don’t fully understand the severity of these diseases because many have been virtually eradicated through the successful use of vaccines. Though some crippling effects of polio still linger, it is rare to come across someone wearing braces or using a wheelchair as a result of a polio infection in the U.S. Many vaccine-preventable diseases can cause death during the initial acute illness and if the individual survives, he or she may be left with chronic effects that last a lifetime. Polio can lead to temporary or permanent paralysis, deformities in the hips, ankles and feet; measles, mumps and varicella can all lead to brain damage and mumps is known to cause deafness; hepatitis B can cause permanent liver damage and even liver cancer. The list of damaging effects goes on and on.

In some areas throughout the U.S., as many as 1 in 20 kindergarteners have not been vaccinated. As the antivaccination fad grows in American so do the infectious disease rates. Measles was said to be eliminated from the U.S. in 2000 but an average of about 60 cases of measles occurs each year, typically from traveling. However, in 2011, there were 17 measles outbreaks in U.S. communities and the number of cases jumped to 222. In 2012, the U.S. had one of the largest pertussis outbreaks in nearly 50 years. Nationwide, over 85,000 vaccine-preventable diseases occur each year. I am not arguing that vaccines have no potential side effects and have never caused adverse effects or even death in children. However, I do think vaccines have done considerably more good than harm. So I urge parents, before deciding to withhold your children from vaccinations, look into the facts and make a decision based on science – not popular news. Although outbreaks of disease have been conquered in the past, many vaccine-preventable diseases remain throughout the world and the U.S. is not immune to future outbreaks.

 

Post Polio Syndrome Week – No Presidential Proclamation Required

Student guest post by Ron Bedford.

The first week of February 2010 must have been some sort of Post Polio Syndrome (PPS) week. The New York Times ran a story about PPS on February 2nd.
On the following Saturday, during the broadcast of the 2009 AKC/Eukanuba National Championship dog show, a Labrador Retriever named Benton was honored with an AKC Humane Fund Award for Canine Excellence (ACE) in the service category for his work as an assistance dog for his owner, Margo Dietrich, a polio survivor who “lives with physical limitations due to experiencing adult-onset Post Polio Syndrome”.

Since the mid 1950s polio has been characterized as a chronic disease caused by infection with poliovirus, which was all but eradicated from the developed world through mass immunization campaigns and routine vaccination of infants. During the 1980s and 1990s, clinicians and researchers identified PPS among polio survivors who, after 10 or more years of stability, had experienced significant deterioration of their neuromuscular functioning. The Polio Today website of the Salk Institute for Biological Studies describes PPS as “a serious neuromuscular condition … Characterized by extreme fatigue and further weakness or paralysis in the limbs.” Since the onset is typically gradual with symptoms similar to other neurodegenerative diseases, PPS is not easily diagnosed. It is not uncommon for PPS to arise in people that had such a mild case of polio that they were not even aware of the infection.

This is where things start to get interesting and frustrating. Since the last great polio pandemics occurred during the 1950s and 1960s, the numbers of polio survivors are diminishing. In a study prepared for the Board of Directors of Post-Polio Health International, Lawrence C. Becker estimates that there were approximately 426,000 polio survivors living in the U.S. in 2006, 53% of whom were over the age of 65.

The cost/benefit analyses may not work in favor of those afflicted to fund the research necessary to understand the disease mechanisms and find effective treatment modalities, but polio and PPS won’t disappear any time soon. Despite the efforts of the WHO to eradicate polio worldwide, the virus remains endemic in parts of sub-Saharan Africa and the Indian subcontinent. This WHO webpage lists the countries where cases of polio have been diagnosed recently and the accompanying map shows locations of outbreaks of wild poliovirus in the last 6 months. The WHO currently estimates that there are “10 to 20 million polio survivors worldwide … one of the largest groups with physical disabilities in the world.”

There are also reports of sporadic outbreaks elsewhere, such as among communities that discourage routine vaccination of infants and among people with compromised immune systems, such as the cases described in this 2009 blog by virology Professor, Vincent Racaniello.

Whether the virus is wild type or vaccine associated, the approximately one percent of individuals infected with polio who develop paralytic symptoms will continue to suffer with the chronic phase of the disease long after being “cured” of the infection. Since the mechanism of PPS occurrence is not well understood, it should be assumed that the syndrome will continue to manifest in 20-80% of polio survivors, the current range of prevalence estimates, though Polio Today puts the estimate at 40-50%.

Recent research projects report evidence of potential immune system involvement leading to nerve tissue damage due to inflammatory processes. The causes of the inflammation are as yet unknown, but Susan Perlman, M.D., Clinical Professor of Neurology at UCLA and Ask the Expert columnist on the Polio Today website reports encouraging results in clinical trials, European studies, and her own treatment of a handful of patients with intravenously administered immunoglobulin (IVIG) to “flush out bad antibodies attacking neuromuscular junctions.”

A study by Gonzalez et al. in the Journal of Proteomics reported identification of potential protein biomarkers for PPS which, according to the authors, would aid in the diagnosis of PPS, but would also also support hypotheses of possible immune mediated inflammation and nerve damage causing the observed neurodegeneration. The researchers examined cerebrospinal fluid of PPS patients, healthy controls, negative controls with other non-inflammatory diseases, and subjects with secondary progressive multiple sclerosis. The protein expression profiles clearly distinguished the PPS patients from other subjects in the study. The authors interpret their findings to support studies with IVIG such as those referred to by Dr. Perlman. One stated potential limitation of this study is that no polio survivors without PPS were included, so it is impossible to say whether the proteomic aberrations would be specific to PPS or would be expected to identify subjects with stable neuromuscular conditions after paralytic polio as well (Gonzalez et al., 2009).

Both of these areas of study identify potentially beneficial treatments for PPS. Both are also deserving of further research and funding to find and treat the causes of this debilitating late onset consequence of an infectious cause of a chronic disease.

References

Gonzalez, H., Ottervald, J., Nilsson, K. C., Sjogren, N., Miliotis, T., Von Bahr, H., et al. (2009). Identification of novel candidate protein biomarkers for the post-polio syndrome – implications for diagnosis, neurodegeneration and neuroinflammation. Journal of Proteomics, 71(6), 670-681.