Ask Before They Play To Keep Chickenpox, Pertussis and Measles Away
Jul 15, 2014

Part One: Why Ask at All?

By Dr. Lara Zibners

 “Oh, you know, we never had baby gates, because, you know, of the controversy.”

This was the response I got from a mom at a playgroup after some random conversation about safety. Our house had a flight of stairs just off the living room that was 16 wooden steps ending directly onto a slab of stone. So we had baby gates at either end. The story was likely the one about me installing these gates and then calling the company to find out how to open them. They were that good. Anyway, it made perfect sense to me that small children + long staircase + stone floor = potential significant injury. Until that exact moment, I was unaware there was a “controversy.”

Yet, apparently this other mother had read something about boundaries and teaching children to respect the staircase from behind imaginary walls. Which would then in turn help them develop self-control. Whatever. To my mind, having your frontal lobe all bruised up after a flight down a staircase would also create long-lasting issues, so I went for the option with an immediate safety return.

If you look between the lines of this exchange, you can see that it’s not so different from finding out that this mother was a vaccine-refusing parent. Her philosophy about parenting was so incredibly different that mine, and her ideas seemed so far out there, that I had no answer for her. Just a smile and a nod. (And a snarky comment about traumatic brain injury—I couldn’t help myself.)

Is that really so different from mentioning your child’s flu shot appointment and being met with a response that implies (or flat out says) that the flu is not dangerous and actually good for building their natural immunity? Those of you who are convinced that immunization is the most effective way of protecting your children from a variety of preventable and life-threatening illnesses have already made peace with this decision. If, on the other hand, you’ve chosen to vaccinate but still have questions than I suggest you continue to hang around sites like this. The more you learn about the scientific evidence that supports immunizations, the more certain you will be in your decision.

But what do you do when you find out about parents who have made other decisions?  What do you do when you discover your child’s best friend is unvaccinated? Should you care? After all, is it any of your business?

To answer the last point first, of course you should care. When rates of vaccination drop, rates of vaccine-preventable illnesses go up. That is fact. It might be tempting to think that this is simply the cost to individuals who choose not to vaccinate: the very real risk of a life-threatening illness. But it’s not that simple. Firstly, those at risk of contracting an illness such as measles, mumps or whooping cough are both the unvaccinated and the vaccinated. No vaccine is 100% effective in preventing illness. Most vaccines therefore rely on herd immunity. That’s a whole post in and of itself, but trust me, the more people who are vaccinated, the fewer cases of illness; the infection just can’t spread as easily.

Now you may be thinking, if vaccines don’t give 100% protection, why bother? But the reality is that vaccinating can prevent many of the complications, even sometimes make an illness no longer contagious, so it’s not a game of all or nothing. For example, wild-type chickenpox is pretty darn catching. As in a non-immune person has an 80-90% chance of becoming infected after exposure. A little kid who has had the varicella vaccine can still get chickenpox. But the risk is decreased by 98% after the second dose.  And yes, it’s true that a child can actually catch chickenpox after the shot. But only about 1% do and then it’s a mild case that is virtually free of complication and is rarely contagious. And by rarely contagious, I mean there are 5 reported cases of chickenpox transmitted from a recently vaccinated person to a non-vaccinated person over 55 million doses. So, technically, vaccine-related chickenpox is contagious. But my real hair color is technically mouse brown and good luck finding a single strand of it on my head, you know what I’m saying? So back to the point. Even if vaccines aren’t 100% effective, they are still mighty protective.

Secondly, what about children who are unvaccinated because they are either too young or have a medical contraindication? You may be putting them at risk as well. For instance, babies under 6 months who haven’t had 3 primary doses are at significant risk for an overwhelming pneumococcal infection. The first series of shots (giving minimal protection) to pertussis aren’t allowed before 6 to 8 weeks. And measles and chickenpox vaccination doesn’t begin until one year. What about a child who has cancer? This kid is at risk from the most benign of infectious diseases. Not to mention the fact that cancer treatment can erase all the protection a child may have had from prior immunizations. Some kids either have no protection or are medically not eligible for certain vaccines. That is fact. Which means these kids rely heavily on the rest of us to stay safe. Babies and sick kids. Our most vulnerable populations at risk from those who have willingly not vaccinated.

But beyond that, we may want to consider the parenting philosophy behind that decision to not vaccinate.

Is this an issue that is so big, so important, that I’m not going to allow my children to play in that home? Many of you are familiar with the push to ask about loaded weapons in the home before allowing your child to play there. Is the refusal to vaccinate the equivalent to a loaded shotgun sitting on the kitchen table? Does this family have an approach to child-rearing that is so diametrically opposed to your own that you want to limit your child’s exposure or have difficulty trusting the other parents to support your parenting decisions and rules?

And while there are lots of other reasons why immunization programs are essential for both individual and societal reasons, as my last point I want to emphasize that we have a duty to try and protect families who are willingly unvaccinated. I would never consider illness something to be deserved. That means I don’t say “I told you so” when I meet a parent whose unvaccinated child has whooping cough, and I certainly don’t walk away from a child who needs my help. Vaccination is a social obligation, one that stretches beyond our own children and becomes a moral responsibility. It is our duty to stand up for our beliefs and extend a hand to those families who are uncertain about vaccination.  In doing so we may help others make positive decisions that can ensure the safety of as many others as possible.

While there are societal considerations, if you allow unvaccinated children to play with your own you’re increasing the risk of your fully vaccinated child catching one of these diseases you’ve worked so hard to protect her from. So, yes, you should care.

Great. That’s settled. So now what do you actually say?

Check back later this week for the second part of this blog series when I will explore some specific suggestions on how you can open the conversational door on immunization. In the meantime, feel free to comment below on why you feel it’s important to know the immunization status of your child’s playmates. 

Dr. Lara Zibners is board certified in both general pediatrics and pediatric emergency medicine.  As the author of the award-winning book “If Your Kid Eats This Book, Everything Will Still Be Okay,” and a hilarious blog, Dr. Zibners has been an avid and very public supporter of vaccination.

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