Vaccinations: Effective or Dangerous

We are starting our series with the topic of vaccinations, one of the controversial areas of preventive health care.  The arguments for and against vaccination are passionate and complicated.  This topic includes discussions on personal risk, personal rights, public good and public responsibilities.  The consequences are real.  Small outbreaks of Pertussis and Measles demonstrate a vulnerability in our population as the vaccine rates drop below critical levels.  And in California, families choosing not to vaccinate are having to home school their children.

Vaccination is the administration of antigenic material (a vaccine) to stimulate an individual’s immune system to develop adaptive immunity to a pathogen.  The vaccine is training our immune system to recognize and prevent a serious infection.  It is an example of true preventive care (vs early screening for asymptomatic disease) and one of the most natural and holistic services offered by traditional or allopathic medical practitioners.

The effectiveness of vaccines are well documented, however, our memory is waning, because the majority of us were children or not alive when these infections were common.   I do remember my Mother and Father taking me to our school on a weekend to swallow a sugar cube with polio vaccine.  I experienced measles, mumps, rubella and chickenpox. I had a chickenpox party.  My first ICU patient as an Intern survived tetanus.  I lost a pregnant mother to chickenpox pneumonia.  And I participated in the two mile Whiskeytown lake swim with my patient with post polio syndrome.  She loved being in the water.

The effectiveness of the recommended vaccinations is so dramatic, you do not need to read or study medical journals to appreciate the effects.  I queried Google images with the following:  United States, CDC, Vaccine Graphs and the individual viral illness. ( I apologize in advance for any violation of copyright rules.  It was for a good intention.)

polio-cases3
us-diphtheria-rm-1900-1967
cases-pertussis-nationwide_2_t600
tetanus-deaths
vaccine-measles-cases-1950
s1-reutersmedia-net
varicella-cases-1972-2011b
                                Hepatitis A
hepa-fig-02
us-flu-1900-2002
Choosing to vaccinate seems to be an easy decision, but as with all interventions, there can be complications.  The majority are mild reactions such as rashes, headaches, sore arms, etc.  Serious reactions are rare and include very high fevers, seizures, severe allergic reactions, and unfortunately, even death.  Vaccinations with live virus sometimes cause infections similar (milder) to the wild viral infection, and are contraindicated in people with immune suppression.

The benefits of vaccination were severely questioned after the publication of Andrew Wakefield in The Lancet linked the MMR vaccine with Autism.  The article was later retracted and additional studies did not confirm his findings.  Unfortunately, the controversy has continued and is one factor in a decline in our vaccination rate, and an outbreaks of infection.  Between 1989 and 1991, 55,000 measles cases were reported and 123 children died.  Recently, there was a small outbreak at the Disneyland theme park in LA.

The logic of vaccination is challenged by the concepts of diminishing returns and herd immunity.  The graphs demonstrate the dramatic decline in illness following mass vaccination programs.  However, to maintain these results we must continue the vaccination programs without any additional changes in the activity of the illness, unless, of course, the illness can be eliminated completely like smallpox or polio.  The benefits are even less evident on an individual basis, because once the vaccinated population reaches a critical level, the next person vaccinated does not further the goal of suppressing the propagation of the infection.  They assume risk without any personal or community benefit.

There are individuals who have contraindications for vaccinations, and these “free-passes” are saved for them.  For example, people who are immune suppressed cannot receive a live viral vaccination.  And young babies will not respond to vaccines until there immune systems mature.  They depend on the people around them to shield them with their immunity.

People who refuse vaccination based on their personal beliefs have the right to refuse.  They do have an additional responsibility to not expose others who are not able to vaccinate.  You would feel terrible if you passed an infection to someone who did not have the option to vaccinate.

In the next few weeks I will be exposed to many patients with Influenza.  You should feel a little more comfortable knowing I have chosen to have the vaccine, if you need to see me during the flu season.

The discovery of vaccines is one of the most important events in modern medicine.  It has saved countless lives and improved our quality of life.  For those who trust me with their healthcare, it is important to know and understand my beliefs on this topic.

If you have not had a review of your health care, because you do not have a medial provider, or just cannot find the time to make an appointment, we encourage you to walk-in to Hilltop Medical Clinic for a physical exam.  You will be informed of the latest recommendations and assisted with referrals for necessary services.  You will be able to choose the services that are important to you without pressure or judgement.  And please remember, although there is no deductible or copay cost for preventive care, these services are not free.  You have prepaid for preventive care services with your monthly insurance premiums.

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