Shot of Prevention

By Christine Vara

Yesterday, I read an LA Times article, written by Pamela Nguyen, a resident physician in pediatrics at UCLA’s Mattel Children’s Hospital.  Sadly, the article confirmed what I had already suspected.  Due to the fact that vaccines have been highly effective, it is not uncommon for medical students and residents to go through their training without ever seeing vaccine preventable diseases such as measles, mumps and pertussis.   

While on the one hand this statement can be considered a rallying cry for vaccine advocates, on the other hand, some are smart enough to realize that this is why we find ourselves at risk.   Without prevalent disease society fails to see a threat.  Subsequesntly there is less fear of disease and some wrongly believe less need for immunization.     

In referring to measles, Ms. Nguyen states that, “In four years as a medical student and three years as a pediatric resident, I have never seen a case. As a result, all I know about the illness, I learned from textbooks.”  However, she substantiates the significance of measles by stating that “According to the Centers for Disease Control and Prevention, the disease remains the leading cause of vaccine-preventable deaths in children. In 2007, there were 197,000 measles deaths worldwide, 90% of them in children younger than 5. That is nearly 450 deaths every day.”

What these statistics suggest is that although vaccines have been effective in limiting the number of cases we see in this country, vaccine refusal and inaccessibility continues to perpetuate the risks of diseases making a comeback here in the states, as they still remain a concern worldwide. 

What I found to be especially compelling was her recent encounter with a patient who had brought her five year old child in for an H1N1 shot.  Surprisingly, the child had never received any other immunization.  When offered other vaccines, she again declined.    

As Ms. Nguyen states, “She explained matter-of-factly that it was because the flu was “going around” whereas the other vaccine-preventable diseases, she said, were no longer a threat.  She went on to tell me that she was a lawyer who had grown up in a country where measles is still endemic. Since moving to the U.S., she had never known anyone to suffer from measles, but she did know several children who had autism. So, while she understood that vaccinations had not been definitively shown to cause autism, she felt that, here in America, the risk of autism was a bigger threat than that of vaccine-preventable diseases.”

Basically what this says to me is that fear is an effective motivator.  In this case, fear of the unsubstantiated suggestion that vaccines can cause autism prompted this parent to decline all vaccines for her child.   However, publicized deaths as a result of H1N1 created enough fear to drive this same person to receive a vaccine. 

Does this make sense?  Are we a society that only responds to fear and not common sense?  And if so, are we not fearful when we hear of an infant diagnosed, or even dying, from a vaccine preventable disease? 

We need only to look at another LA Times article to prove this point.  It details a “cautionary tale” of a new mom, who unknowingly infected her two children with pertussis, resulting in the death of her 17 day old son Dylan. 

The article explains that the problem was in the diagnosis.  Dylan’s mother had a serious cough for several weeks prior to delivery.  She encountered a variety of doctors and medical personnel during that time, but only the pediatrician checking Dylan seemed to suspect that she had pertussis. Even then, that suspicion failed to elicit treatment.  When following up with her physician, he dismissed the possibility of pertussis and diagnosed her with a cold. Perhaps this goes back to the “learning from textbook” phenomenon.  As a doctor, if you’ve never seen it and think it’s rare, than it’s unlikely you would diagnose it.    

The sad reality is that pertussis is highly infectious and extremely dangerous for infants.  As the article states, four newborns, all younger than 3 months, have died in California so far this year, already exceeding last year’s total of three whooping cough-related deaths. 

I would venture to guess that the Bianchi family would encourage others to receive booster shots in order to protect themselves and other infant children from pertussis; much like we are seeing with Callie Van Tornhout’s family and countless other parents who currently advocate for vaccines.  But why does this kind of awareness have to come at such a price?  What steps must we take to ensure that every child is protected? 

Ms. Nguyen’s concludes her article with a call to action.  “It is time to change our perspective and make the safety of all children our priority.  The first step is to demand stricter guidelines for personal-belief exemptions. Vaccinations should be mandatory for public school entry in all but the rarest of cases. The next step is to put pressure on private and charter schools to follow these same guidelines. It is selfish for parents who intentionally don’t vaccinate to make other children vulnerable.”  I would like to add that we should be encouraging booster shots for adults as well, to limit disease in general and to protect those too young to be vaccinated. 

Do you feel the need to address vaccine refusal in order to reduce risk of disease to the greater public?  Is fear the only motivator that will prove to be effective?  In what ways can we approach this challenge?  Share your comments so that we can all be part of the conversation and solution.