The rates of non-immunization in the different schools on Kauai were recently reported in Civil Beat. The non-immunization rates for a few of these schools are high enough to be of real concern. This report came out a few days ago and has generated aggressive debate. I, like most pediatricians these days, have been involved in this discussion for most of my professional life. This article is an attempt to address many of the issues that seem to be at the heart of the debate.
Opponents of vaccinations often point to the distortion of science for profit. They are correct; science these days is often distorted by a profit motive: the tobacco industry, the sugar industry, the chemical and plastic industries, big oil and big pharma, have all played a significant role in rolling out theories and “proofs” that are not true.
The opioid epidemic, for example, seems to have exploded into the serious problem it is today by false information spread by the manufacturer of the drug, oxycontin.
A very important difference between the recommendations about vaccines and the information provided by the companies above is that the recommendations and safety monitoring of vaccines is watched over by the American Academy of Pediatrics.
The AAP is not for profit nor for sale. We, the pediatricians and pediatric specialists of America, are its membership. The AAP has scientific committees examining and following almost everything that affects childhood health and their advice is heeded around the world. For example, my concerns about chronic pesticide exposure began with the AAP’s reporting on the potential dangers.
The AAP has not backed away from any battle for a healthier environment. Their most recent review concerned the lack of regulation in food additives and they were vehement in their criticism of the poor regulatory systems and the dangers of many of the chemicals allowed in our food.
One needs to carefully pick the experts they believe. The carefully researched AAP recommendations carry much more scientific value then the distorted and often misleading evidence which can be presented by anybody on the internet.
There was a sad story in the news recently about a 7-week-old baby in the mainland who died from a type of meningitis that is not yet vaccine preventable.
I was struck by how tragic the story was and also struck that a mainland case of meningitis is now national news. In comparison, in my first 11 months as a practicing pediatrician (43 years ago) in a small rural hospital, we diagnosed and treated 11 cases of bacterial meningitis.
Because meningitis was so common, I doubt if any of the cases made even the local news. Bacterial meningitis is an infection of the brain. In those days, we considered the diagnosis of meningitis with almost every child we saw with a fever who looked sick.
We worried because a delay in treatment almost invariably led to severe brain damage or death. There are now vaccines against three different types of meningitis. I have not seen a case of bacterial meningitis in 30 years.
Not only is bacterial meningitis dramatically less in vaccinated children it is now also less common in non-vaccinated children. This is because of what we call “herd immunity” or “community immunity.”
Without vaccines, diseases can travel quickly through a community, making many people sick. But if enough people are vaccinated against a disease, it can’t travel as easily from person to person — and the entire community is less likely to get the disease.
When vaccination rates are high, even people who can’t get vaccinated (because they are too young or have weakened immune systems) have some protection. When vaccination rates are lower, everyone is at greater risk.
The overall vaccination rate on Kauai is greater than 95 percent. The vaccinated children are protecting the unvaccinated children by this herd immunity as there are far fewer of these diseases going around, but if one of these very contagious diseases like measles or whooping cough or even bacterial meningitis arrives in a small, closed community like a school and a large number of students are not vaccinated, the disease can spread very quickly.
Most diseases are particularly frightening in children under the age of one and when siblings come home from school with these diseases, they can easily spread them to these young vulnerable babies. Neither parents nor physicians ever forgets taking care of a small baby with whooping cough.
The babies may turn blue with coughing. You wait anxiously for the coughing to stop and the pink color to return and then you wait again for the next frightening coughing episode. Whooping cough in very young infants is particularly frightening as it may cause death.
We have more than a million tourists per year from all of the world, our potential exposure to diseases is high. We had a measles epidemic in 1984, we had a mumps epidemic in 2017, and we regularly have small outbreaks of whooping cough. Because the herd immunity is pretty good on Kauai, these diseases usually result in a small cluster and then fade away.
If and when the herd immunity is not good, these diseases can spread rapidly. It should also be noted that you can get a disease even with vaccination.
The MMR, for example, fully protects 97 percent of those who have had two shots. Three percent could still get measles if they were exposed. The 3 percent are also protected by high immunization rates.
A concern expressed by parents is that vaccines, particularly MMR, causes autism. This has been studied extensively and there is no evidence for this. The most recent reassuring study is out of Denmark and was reported in March of 2019. The researchers followed over 650,000 children.
They tracked over 14 years the 95 percent who had been immunized with MMR vs those who had not been immunized. There was no difference in the incidence of autism in the two groups. This study was large enough that it could look at groups of children who might be at higher risk for autism, such as those with a sibling with autism.
There was no difference related to MMR vaccination in these children either. There are actually 17 other studies in various countries with similar findings.
The number of vaccinations given by age 2 has increased and this is concerning to many parents. The number of vaccinations given by age 2 has increased from 5 in 1980 to 26 in 2012.
What is not well known is that the number of antigens, which are substances in the vaccine that cause disease resistance and possible reactions, have gone from over 3000 in those 5 earlier vaccines to about 150 in all 26 vaccines given today. The reason is that the vaccinations have been greatly purified. There is actually much less fever and fussiness after these newer vaccines.
Mercury and aluminum in the vaccinations is another hot topic. Because of concerns about mercury as a preservative in the vaccines, the AAP strongly supported its removal. It is no longer in any vaccine except for one type of flu vaccine. The concern was that mercury could be playing a role in the increasing number of children with autism and/or attention deficit disorders.
It was a reasonable theory, but unfortunately the rates of those disorders have not decreased since the removal some years ago. There are still very small amounts of aluminum in some vaccines as an additive. Aluminum is actually the most common naturally occurring metal on the planet and by six months of age a baby will have received much more aluminum from breast milk then from the shots.
When I was a toddler, people avoided going out in crowds because polio was rampant. Hospitals were filled with paralyzed people of all ages.
Patients were often so sick that they needed a new invention called an iron lung to help them breathe. Polio disappeared almost overnight when I was in kindergarten as the polio vaccine became available across the country and then across the world.
Good debate is important, but I am very concerned that the misinformation and distorted reporting in much of the anti-vaccination literature could return us to a world where diseases which are now rare could return. Please vaccinate your children.
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Lee A. Evslin, MD, was the former CEO of Kauai Medical Clinic and Wilcox Hospital. He recently served on the state-commissioned task force which examined pesticide use on Kauai.
