Originally published in The Ottawa Citizen July 4, 2001

We know all too well the pain and suffering the victim, their families and friends endure from the scourge of AIDs. Imagine it’s the year 2051 and there is a vaccine for AIDs. AIDs has been virtually eliminated. Small outbreaks continue to occur but for the most part people have begun to forget what it was like to have a family member die from AIDs.

A movement begins stating that there is no further need to vaccinate your children. They fear that the vaccine will weaken their immune system, cause terrible side effects and physical harm. Despite reams of evidence demonstrating the efficacy and safety of the vaccine, some people stop vaccinating their children. Soon the level of HIV infection increases and people once again begin to die a horrible death. People who lived through the AIDs epidemic are aghast. “Why”, they say, “when overwhelming evidence clearly shows the effectiveness of the vaccine would some refuse it and promote its non-use to others? Why invite this deadly illness back to re-infect our children once again?”

Just as we have urgent appeals today to stop the scourge of AIDs, Hepatitis C and cancer to name a few, so too it was that parents would have done anything fifty years ago to save their children from the horrible diseases of that time. How many people would deny themselves or their children a vaccine for AIDs?

This scenario is being played out right now in most communities in the Western World. Some people are not vaccinating their children because of fear and misinformation provided by anti-vaccination advocacy groups. I for one am at a loss to understand why we would increase a child’s risk to deadly diseases that we were once praying to God for a cure. I am sure these groups believe that they are acting in the best interests of the children but in their zeal they misrepresent the facts and foster a belief system that becomes difficult to change. Some people that once feared the disease now worry about the safety of the vaccine. Let’s start to change these views with documented factual information.

There are two standard vaccines that are given to children from infancy to the toddler years. PENTA ((pertussis)whooping cough, diphtheria, tetanus, polio, and Hemophilus Influenza B) is given at 2, 4, 6 and 18 months of age and PRIORIX (measles, mumps and rubella) given at 12 months and 4 years of age. Other vaccines recommended by the Canadian and American Pediatric Societies are Hepatitis B (Engerix and Recombivax), Varivax II for Chicken Pox . Prevnar has just been approved for ear infections, meningitis and pneumonia caused by Streptococcus pneumonia (the infection that killed Jim Henson in four days).

Contrary to some opinions, vaccinations do not weaken your immune system. They stimulate your immune system to produce antibodies, which act to destroy invading disease organisms. Antibodies are like soldiers. It is easier to defend against an invader with a standing army at the ready than trying to recruit your soldiers during a surprise attack. You may not be able to mobilize enough soldiers to destroy the attacking force. In order for your immune system to be healthy and functioning at peak efficiency it needs to be continually stimulated and challenged; a biological arms build-up.

I think it is important for people to know what diseases are prevented with vaccination and the risks if the decision is made not to vaccinate.

Diptheria

Diptheria is a bacterial throat infection that kills 1 in 10 people despite treatment. It can produce a toxin that can causes the throat to swell and forms a thick filmy membrane that becomes large enough to suffocate its victim. The toxin can be absorbed into the body and cause damage to the heart, kidneys and nerves.

The vaccine, developed in the 1920’s reduced the rates of infection from 9000 cases in 1924 to less than five per year since 1983.

Pertussis (Whooping Cough)

Pertussis is a bacterial nose, throat and lung infection. It kills 1 in 400 infants and 1 in 400 suffer brain damage. Areas of the lung can fill up with mucous and collapse. 20 to 30% of infants are admitted to hospital because of how sick they become. The incessant coughing can cause the blood vessels in the brain to rupture, cause the infant to stop breathing and block the flow of blood to the brain. Complications include pneumonia and ear infections.

The vaccine has been reformulated to dramatically reduce the side effects of fever, crying, swelling, pain and redness at the injection site. It protects about 70% of children. In spite of this percentage, it reduces the severity of the illness in children compared to those who remain unvaccinated. Those most at risk for complications are children under the age of 6 months but it is used up to the age of seven. The complications from the disease are less severe in older children and adults. In Sweden, Japan and Italy, vaccine discontinuation resulted in a dramatic increase in the number of new cases.

Tetanus

Tetanus is caused by a toxin produced by the bacteria Clostridium tetani. It attacks the nervous system and causes severe painful muscle contractions that can stop you from breathing.

In the early 1900’s there were over 5000 cases per year mostly in newborns, older boys and young men. In the past 15 years there have been fewer than 2 cases per year in Canada. Since 1984 there has not been one case of tetanus in newborns.

The vaccine contains the deactivated tetanus toxin. It cannot give you tetanus.

Polio

Polio is a viral infection that permanently affects nerve cells in the spinal cord that control the muscles in your body. These nerve cells die leading to paralysis of the legs or arms and in some cases, death. About 1 in 100 who suffer from the disease develop paralysis.

The vaccine became available in 1955 when the total number of cases of paralytic polio in Canada, the U.S., the former Soviet Union, Western Europe, Australia and New Zealand was more than 76,000. This means over 7,600,000 people contracted the disease that year. By 1967 the total number of cases of paralytic polio for the year was 1,013 for those same countries; a reduction of over 99%. The last case of paralytic polio in Canada was in 1989.

The vaccine used in Canada is a killed virus (inactivated). It cannot cause polio.

Haemophilus influenza b (Hib)

This bacteria causes meningitis and blood, bone, lung, joint, skin and ear infections. It has nothing to do with the flu. Prior to 1985 in was the most common cause of meningitis in children in Canada with 1500 cases every year in children under 5 years of age. 1 in 300 Canadian children developed meningitis or other severe infections by age 5.

In 1985 there were 495 children admitted to hospital with Hib infection. The vaccine program began in 1986. By 1996 that number was reduced to eight, ­a decrease of 98%.

The vaccine is made of small purified pieces of the bacterial outer shell or protective coat. There is no possibility of contracting the disease from this vaccine.

Measles

Measles is a highly contagious severe viral infection that causes inflammation of the brain (encephalitis) in 1 out of every 1000 cases often leading to permanent brain damage. Everyone contracted measles before the age of 18 in Canada and epidemics occurred every 2 to 3 years prior to the arrival of the vaccine. There was an average of 350,000 cases every year with 90% of those affected under the age of ten. Each year it was responsible for 50 to 75 deaths, 5,000 hospital admissions and 400 cases of encephalitis.

Soon after the vaccine was released in 1963, the number of cases dramatically fell. There were 2,000 cases in 1995.

The vaccine is a live attenuated one. This means that it is weakened compared to the wild strain which causes natural measles. It is effective in 95% of all children when given after their first birthday. A booster dose is given at four years of age to increase the immunity rate to close to 100%. Immunity is lifelong.

There are claims that the measles vaccine is associated with autism. To date there is insufficient evidence to support this claim. Further the recent fear of a certain vaccine preservative which contains mercury could be a link to autism is not applicable for Canadian vaccines. This preservative is not used in this or any other Canadian vaccine. The risk of developing encephalitis from the vaccine has been difficult to determine because it is so rare. It is estimated to be less than one per one million doses.

Mumps

This viral infection causes meningitis in 1 out of 10 people. Mumps meningitis is usually mild and does not cause permanent brain damage. In some cases it causes encephalitis (brain swelling) that can lead to permanent brain damage. Other complications include deafness, painful swelling of the testicles in teenage boys and men and painful infection of the ovaries in women.

Before the vaccine the rate of infection was 1 out of every 6 susceptible children. Although mumps did not cause significant damage to the children it was determined that the cost of treating the disease was far more expensive compared with the safety, effectiveness and the cost of the vaccine. Today the number of cases of mumps has fallen by 90% with no reports of encephalitis.

As with the Measles vaccine, it is a live attenuated virus which does not cause the mumps infection in most people. The mumps vaccine risk of causing mumps meningitis is 1 in 800,000 compared to 1 in 10 due to the natural mumps virus.

Rubella

Also known as German Measles, this virus is fairly mild in children but worse for teens and adults. The big problem is contracting rubella when pregnant which causes birth defects and can kill the unborn child. This is Congenital Rubella Syndrome (CRS)

Prior to the vaccine, by the time of your twentieth birthday, 85% of people already had rubella. Those left unaffected could still catch the disease. Of course, childbearing women were most at risk.

Since the start of routine immunization in 1980, the number of babies born with CRS dropped from 2000 to 2 cases per year.

It too is a live attenuated virus but rarely produces any side effects.

Hepatitis B

This virus infects the liver. It is extremely contagious and easier to catch than the AIDs virus, HIV. It is found in every body secretion and can be transmitted through sexual activity, contaminated needles, tattooing, breastfeeding, toothbrushes and razors. It is an extremely hardy virus. You can take a syringe containing the virus, bury it, let it sit underground all winter, dig it up in the spring, add water and presto! You now have active Hepatitis B virus. I had one of my 18 month old patients pick up a syringe they found in a park and suck on it. The syringe was indeed contaminated with Hepatitis B.

Approximately 300 to 350 million people are chronic carriers of this disease. In Canada about 1 person in 200 is a chronic carrier. There are 20,000 new infections each year. About 10% of those will become chronic carriers. The danger is that newborn exposure to this virus can result in liver cancer later in life nine times out of ten.

The vaccine contains pieces of the protective shell that surrounds the virus. The Hepatitis B virus is not present in the vaccine. It does not come from blood products. There are few if any side effects and it provides at least 10 years of immunity and probably much longer in 95% of all recipients.

The New Vaccines

Varivax II (Chicken Pox)

This disease is caused by the Varicella Zoster Virus. Most people believe that Chicken Pox is a benign disease that causes little harm save some itching and discomfort. By the age of twenty, 95% have had the disease. The complications of this disease include skin and soft tissue infection, ear, eye, nose and throat infections, serious bacterial infections like necrotizing fasciitis (“flesh eating disease”), pneumonia, encephalitis and meningitis.

According to Dr. Steven Moss (Assistant Professor of Pediatrics at the University of Toronto, Consultant Pediatrician at the North York General Hospital and staff in Pediatric Emergency Medicine at the Hospital for Sick Children in Toronto) the complication rate for chicken pox is 1 in 75. In Canada 2000 children admitted to hospital due to complications last year. Of those there were 12 deaths. Over 90% of these children were healthy.

The vaccine has been in use in Japan for 27 years and in the United States for 13 years. Twenty-seven US States mandate Varivax inoculation prior to admission into daycare.

Over 20 million doses have been given. The only side effects of the live attenuated vaccine are a 2 to 5% chance of a low-grade fever and 3 to 6% chance of a local rash at the injection site. No other side effects have been reported. The vaccine will completely protect 90% of those vaccinated. The remaining 10% will have partially immunity. Instead of the usual average 350 pox marks they will experience about 30. It will still reduce their complication risk.

Once one has had the chicken pox their lifetime risk for developing Shingles, a large bubbled painful rash on your body or face is 1 in 5. If vaccinated this risk drops to 1.5 per 100,000. The vaccine is not used in those people who have already had chicken pox.

Prevnar (Pneumococcal vaccine)

Approved for use in Canada on June 25, 2001, Prevnar is recommended from birth to 9 years of age. This is the first vaccine that is able to protect young children from the Streptococcal pneumonia bacteria. This organism causes blood infections, meningitis, pneumonia, middle ear and sinus infections. It is the most common cause of meningitis in children in the United States. In children between 1 to 23 months of age, the incidence of pneumococcal meningitis is approximately 7 per 100,000. Death occurs in 8%, brain damage in 25% and hearing loss in 32% of children with meningitis. It is responsible for 20 to 40% of all middle ear infections. Antibiotic resistance to this organism is on the rise world-wide. The most common side effects of the vaccine are pain, redness and swelling at the injection site.

It is important to understand why we vaccinate. I think it is important to know about the diseases that threaten your child’s life. I believe it is paramount that patients be kept informed. I encourage you to ask questions of your physician about the vaccines recommended for your child. An excellent resource that I use is “Your Child’s Best Shot, A Parent’s Guide to Vaccination” published by the Canadian Pediatric Society.

I have only touched the surface of evidence that proves the safety and usefulness of our vaccination program. Our goal as parents is to protect our children from harm. Of course vaccines do not protect everyone one hundred percent of the time. Nothing in this world is perfect. But it is of paramount importance to look at the evidence. Sweden, Japan, Australia and the United Kingdom all at one point discontinued the Diptheria, Pertussis and Tetanus vaccination programs due to the anti-vaccination debate. The results were disastrous. The diseases returned and children suffered. These countries reversed their decision and now the diseases are controlled once again.

Claims that vaccines put our children at risk do not stand up well against the facts. It reminds me of the scene in Jerry McGuire. Tom Cruise is on the phone with Cuba Gooding Jr. He asks Tom to blurt out “Show me the money!” as proof of his intentions to help him secure a good contract. With due diligence he does. It is with due diligence that we have never been healthier or lived longer than now. Our good health is considered the norm. It is important to remember your history. Vaccines work. Period. And that’s my two cents worth!

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Internet Sites of Interest:

http://www.uptodate.com/patients
http://www.mayohealth.org/home
http://familydoctor.org/
http://www.cdc.gov/

References:
Your Child’s Best Shot, Canadian Pediatric Society

Opposition to Immunization: A Pattern of Deception, The Scientific Review of Alternative Medicine Vol. 5, No. 1

Varicella Dangers by Dr. Barbara Law. Contemporary Pediatrics, December, 1998

Canada Communicable Disease Report, National Committee on Immunization (NACI): Statement on Recommended Use of Varicella Virus Vaccine. Vol. 25, May 1, 1999.

Prevnar Monograph, Wyeth Ayerst