Written by: “RegularOldJoe”
Back to the original question: “To immunize or not to immunize”. Really, like I mentioned in part one of this topic, the real question is: “Do the benefits of immunizations outweigh the risks?” Part one of this article left us hanging with regards to the hot topic of the MMR vaccine and so this is what I will attempt to discuss here. To answer this with real facts and not just my opinions, we need to break down the issue just a bit. First we will look at why this whole thing exploded into national news in the first place. Then we will talk about the immunization itself. I will not, however, discuss the actual topic of Autism and Autism Spectrum Disorder as that would be a whole discussion in and of itself. Again, slightly long discussion, but really needs to be settled once and for all, so hang in there.
Just like so many things in American life, we base our knowledge on things that we see on TV or the internet. Occasionally we shape our knowledge based on actual life experiences but this is not the case for most Americans, and certainly not with regards to immunization related maladies. To make this point more emphatically, we have to look at the timeline of events that lead up to the entire debate surrounding the topic of MMR vaccine-induced Autism. There was a scientific study that made a loose association that was later proven to be inaccurate, but it wasn’t until Hollywood was affected by Autism and it hit the tabloid rack near the grocery checkout or made the list of hot topics of discussion for the over-opinionated panel of “The View” that we as individual people began to hear of this and began to form opinions of our own. So at this point the debate is based almost entirely on celebrity opinions and the trend among “open minded” people to collectively be individuals.
The grand majority of the confusion came about when Jenny McCarthy, The Playboy Playmate-turned-MTV host-turned-The View panelist became the face of the anti-vaccine trend when she made the claim that her son developed Autism after being immunized. Although it is even questioned now if he actually has Autism, the tidal wave of the anti-vaccine culture was already sweeping the nation. I’m not minimizing the devastation of having a child with significant autism, but sometimes there is not somebody or something to blame for this unfortunate outcome. McCarthy has since recanted with the following statement: “I am not anti-vaccine,” she insists. “I’m in this gray zone of, I think everyone should be aware and educate yourself and ask questions. And if your kid is having a problem, ask your doctor for an alternative way of doing the shots—for example, fewer vaccination doses at the same time”. Nevertheless the discussion became national news and caught on with anybody who wanted to be considered open-minded and not like all the rest of the ignorant lemming-like parents across the nation who run headlong off the cliff by accepting whatever their doctor recommend. (Sorry, I have been told that sarcasm is our family’s “love language”.) I say this mainly because I truly feel that there is a healthy balance between blindly accepting the status quo vs. being completely anti-establishment. I always appreciate when patients ask questions in order to understand as much as possible about their medical conditions and where my recommendations are coming from. I, on the other hand, get very frustrated when people jump on a bandwagon of opposition just because some celebrity has come out with their own personal medical vendetta.
The fact that this question even exists is evidence to the fact that there is a “trust” problem involved. The reason that I say this is because it seems to me that if a parent actually trusts their child’s physician to make recommendations that are well-educated, unbiased and based on the physician’s oath to put the wellbeing of the patient first, then it seems to me that the immunization discussion would be a short one. This, however, is not the case. It seems as though, with growing concerns that the government is conspiring against the people, there have been several outspoken people that have actually made millions selling books about “What your doctor doesn’t want you to know”. A quick Google search will bring up an endless list of people voicing their opinions about how doctors are keeping secrets from you, etc. I’ll add this to my list of future topics of discussion, but for now, suffice it to say that there is a physician trust issue, which may or may not be based on facts.
To further this “thinking persons” discussion, we have to make at least a few baseline assumptions. What are our “Breakfast at Tiffany’s” facts that we can all agree on? First, parents love their children and want the best for them. Second, nobody else loves your children and is as protective of them as much as you are. (I now can say that this applies to parents and grandparents.) Third, there are immoral, unscrupulous people in the world and some of them may have gone to medical school. Taking all this into account, you, the parents, are the only ones that can and should make potentially life-and-death decisions on behalf of your children, and this is why this discussion rages on and IS important. It is not appropriate to dismiss or belittle anybody who has concerns about a medical intervention when they are acting with love on behalf of somebody who is defenseless.
Now that we have made it clear that most parents are acting out of love for their children and we have established that the discussion of immunization safety is worthy of our efforts, let’s spend a little time to educate ourselves on the facts; particularly, with regards to the MMR vaccine and the possible association with autism. Warning, some of this may be a bit dry, but it is important.
The MMR vaccine is a live attenuated vaccine against Measles, Mumps and Rubella (German Measles). This means that the vaccine is made up of live virus that has been genetically selected to not cause disease. Since, however it is the actual virus, the immune system develops antibodies specific to the virus and thus renders excellent immunity. It is given in most countries at about 1 year of age with a second booster at school age, and recently has been recommended for adults entering college (if testing demonstrates a lack of immunity). This came about after Measles outbreaks began to occur on college campuses.
Measles is a highly contagious viral infection that is rapidly spread via airborne droplets and causes a potentially fatal disease. It is classically associated with a very characteristic bright red rash, but it is not just the unsightly rash that is the reason for the vaccine. It is associated with high fever, and respiratory symptoms. Complications occur in about 30% and may include diarrhea, blindness, inflammation of the brain, and pneumonia among others. One of the most important things to remember is how contagious this virus is. Since it is airborne, if a person has Measles, 90% of the unvaccinated people that they come into contact with will get the disease. Measles affects about 20 million people a year, primarily in the developing areas of Africa and Asia. It causes the most vaccine-preventable deaths of any disease. It resulted in about 96,000 deaths in 2013, down from 545,000 deaths in 1990. In 1980, the disease is estimated to have caused 2.6 million deaths per year. Before immunization in the United States between three and four million cases occurred each year. Most of those who are infected and who die are less than five years old. The risk of death among those infected is usually 0.2%, but may be up to 10% in those who have malnutrition. So it is easy to see why a vaccine to measles is a good idea.
Mumps is a much less ominous disease statistically than Measles. It is caused by a virus that is spread from person to person via airborne transmission. It causes an illness with fever and significant swelling of the parotid glands (salivary glands that sit right in front of our ears). In infected males, it can cause significant inflammation and swelling of the testicles and can lead to infertility, but this is actually quite rare. The most dangerous thing that is caused by Mumps infection is meningitis, which can occur in about 10-15% of cases of Mumps and is the leading cause of death from Mumps but according to a fairly exhaustive literature search, this is “very rare”. So all this to say, the main reason that a vaccine to prevent mumps exists is because it’s possible to develop a vaccine to eliminate a virus that commonly causes some significant inconvenient illness in children and could very rarely cause permanent sterility or death.
Rubella is a viral infection that causes “Three day measles” or “German Measles”. Most people who get rubella usually have a mild illness, with symptoms that can include a low-grade fever, sore throat, and a rash that starts on the face and spreads to the rest of the body. Rubella can cause a miscarriage or serious birth defects in an developing baby if a woman is infected while she is pregnant. This is likely the most significant reason that a vaccine exists. If it wasn’t for the miscarriages and birth defects, it would be just another mild viral illness.
(Also a side note: On April 29, 2015, the World Health Organization declared the Americas officially free of rubella transmission. Woohoooo!)
So, in summary, Measles is bad and can kill a lot of people and the vaccine saves lots of lives. Mumps is less bad and only rarely causes permanent damage or death, and Rubella is a mild viral illness that only causes significant problems in unborn children of infected mothers.
I am a physician. I have taken an oath to take care of my patients to the very best of my abilities. Nearly all medical doctors throughout the world have taken some slightly modified version of the original Hippocratic oath upon completion of medical school as a promise to society to never forget the privilege and responsibility that we as physicians have to care for the people who literally trust us with their lives on a daily basis. As you may imagine, I get a bit frustrated by the statements of so many people who truly believe that so many doctors are working with the government to keep their patients ill and dependent upon them as a form of job security. I even have family members who read things on the internet about how the establishment of medicine has squelched breakthrough cures for cancer, diabetes, heart disease etc. in order to keep the big bucks flowing.
With this in mind, please get your children immunized. The immunizations are much safer than the diseases that your children can get if you don’t get them immunized. This is not some sort of government or big capitalistic corporate conspiracy to get your money or harm your children. Please trust your doctor and ask questions if you don’t understand something. We actually appreciate you asking. Lastly, don’t believe everything that some celebrity says on TV or the internet….actors and singers are not really the best source for reliable political advice and certainly not medical advice.