Thursday, November 7, 2013

The Vaccine Question

Everyone who knows me knows that my hobby is infectious disease. I devour everything I can read on the subject. From the historical accounts to the science of treatment and cure or the failure of science to find either a treatment or a cure. I read about outbreaks, containment and fear of outbreaks and what is done to prevent them. I love epidemiology and virology. Of course you can't be immersed in the subject and not read about vaccines and vaccination campaigns. I even read about the ethics and civil rights surrounding those.

That being said, there's a lot of debate right now about vaccinations. You can't be a parent and have someone question whether or not you will choose to vaccinate your child.

The anti-vaccination crowd says that the doctors and vaccination companies use fear mongering to pressure people into putting poisons into their bodies. Make no mistake about it. The fear mongering is alive and well on their side as well. Fear of seizure disorders and Guillian-Barre, autism, etc.

And then there are the vastly uninformed. I've actually had people tell me that no doctor or vaccine ever really cured anything. That the eradication of certain diseases have been because of improved sanitation, not vaccines or improvements in medication.

Those statements are made purely out of ignorance. We have enjoyed several decades of freedom of deadly infectious diseases uncommon in the history of the world due to the combination of improved knowledge and sanitation efforts and through advances in medical technology.

All that being said, I have not vaccinated my children.

If my opinion could be summed up, it was best done by Dr. Russell Alexander when he gave his opinion to a committee about whether or not the government should push a nation-wise vaccination program in 1976 in fear an influenza pandemic was about to strike.

He said, "My view is that you should be conservative about putting foreign material into the human body. That' always true... ... The need should be estimated conservatively. If you don't need to give it, don't."

For better or worse and for those who have asked, here is my guideline for vaccination:

1. Risk Assessment
Some terrible diseases we commonly vaccinate against are pretty much gone from the US and have been gone for several decades. Unless traveling outside of the country or a new outbreak occurs I see no reason to vaccinate my children from those diseases.

Some diseases are mild and the natural immunity has proven to be superior to the artificial immunity. I choose not to vaccinate my child for those.

Some diseases are devastating but contracted through sexual or blood contact. I will reevaluate the need to have my children vaccinated for said diseases when they reach the age where they might be sexually active or come in contact with contaminated bodily fluids.

Some diseases are devastating and still alive and well in the US. I choose to monitor where outbreaks occur and make informed decisions based upon the risk assessment to my family.

2. Determining the Risk of Adverse Reaction
There are vaccines out there that are not commonly given because the chances of adverse reaction are higher than the chances of contracting the disease. But if there were an outbreak it would be better to risk an allergic reaction or lesser symptom than death from the disease.

Every medication has the possibility of side effects, some more-so than others. These days there are many claims that vaccines cause a wide variety of illnesses. How can you know if a vaccine is the cause?

Every year a certain number of people die from heart attacks, strokes and other random illnesses. Every year children are diagnosed with autism. And every year people naturally come down with sicknesses even as strange as Guillian-Barre. The trick is to look at the national average of a particular disease occurring without a vaccine and then to look at the average of that disease occurring in those who have received the vaccine. Unfortunately it's backward science. There usually isn't a need to look for those kinds of causes and effect issues until a certain disease seems to become more prevalent.

The questions occurring right now in many mom circles are the questions of autism and allergies. These seem to be sky-rocketing in the last decade. Is it because of vaccines or is it, in part, because we have gotten better at diagnosing illnesses in individuals we previously assumed to be within the bounds of normal?

There are a lot of people who say that doctors and drug companies cover up evidence of adverse reactions out of greed. Can there be some of that? Sure. But after having read account after account of doctors and scientists who have labored for years and donated their research and tests, spent thousands out of their own pockets to bring a cure to a certain disease out of the concern they have for their patients and their lives, I don't for a second believe that every doctor out there who advocates vaccination does it out of greed. These people see the worst these diseases can do to a human and many feel the risk of a milder reaction far outweighs a reoccurence or contraction of these diseases.

3. Know What The Vaccine Is Going To Do And What It Won't
Some vaccines protect against a disease for life. Some vaccines only protect against a disease for a certain amount of time. Some vaccines only protect against a certain strains of a disease leaving you susceptible to variations or new strains. New strains mutate all the time and therefore new vaccines must be taken often to inoculate against the new strain. Some people wonder why they should bother, then and why the push to vaccinate when it will not last? The hope is for partial immunity. A perfect example of this is the flu. The flu virus is constantly mutating and a new mutation could easily be deadly. If you are immunized from part of the virus, if it comes back in a more violent form you may still get sick but you may not die whereas someone who did not receive any vaccination or natural immunity may very well succumb completely to the disease. The hope is to save lives, not necessarily save you from ever getting sick.

The influenza virus is one of the scariest viruses out there. We think of it as relatively harmless and a few days off work but the truth of the matter is that the flu killed more people in 1918 than the Black Death. Not only is it extremely viral but as many as 17% of people who contract the flu can asymptotically carry and pass it along without ever getting sick themselves. This makes the flu very difficult to contain. There is an international network of scientists and labs monitoring the flu virus all over the world due to the fear and even likelihood of a deadly pandemic. Deadly outbreaks have been successfully contained in places like Hong Kong because of the efficiency and speed of this network.

In my life, I have gotten a single flu vaccination. It was required for work.

I have a very VERY healthy respect for the flu but I do not fear it. When I hear reports of H5N1 spreading and not being contained I will start to line up for the flu shot but until then I'm going to trust a deadly mutation has not occurred and should I contract the flu I will have nothing more than a few miserable days ahead of me.

3. One Vaccination At A Time
If you give an individual 9 vaccinations at one time and s/he has an adverse reaction, how do you know which vaccine is the culprit?

This has been a huge concern amongst parents. These days children are expected to get about 44 doses of about 14 different vaccines before s/he enters kindergarten. That's a lot to give in a very short period of time. Some of the vaccines are lumped together so that even if you are only getting one shot you are getting three different vaccinations. Three shots in a single day can mean nine different doses. It's easy to rationally see how that can be overwhelming for a little body to take in.

I believe in individual dosing for a specific threat of disease and giving time to watch for adverse reactions as well as for the body to build immunity. Certain vaccines can be obtained individually rather than grouped together though some cannot be. Or, rather, your caregiver may not be inclined to prescribe and fool around with obtaining an individual dose. That's for you to battle out with your caregiver. But if you know what you want and where your caregiven can order it from he might be inclined to help you out.

The only time I would break the "one at a time" rule would be if I felt there was an imminent collapse of our medical system on the horizon. In which case I would blanket immunize.

4. Know the Brand of Vaccine
Many people do not know that there are several brands and versions of vaccines. When they say, "I got all my shots as a kid and I'm fine so I see no reason not to vaccinate my children" what they are essentially saying is, "I ate a lasagna my great grandmother made for me when I was a kid and I liked it so there's no reason my child won't like the store bought lasagna I put on her plate today."

Ingredients change. Vaccines are grouped together or apart. Different companies have different cocktails, some with controversial ingredients, some don't. Those ingredients and cocktails come and go. And you won't (and can't) know what you are injecting yourself or your children with without researching the brands your doctor has and their side effects and what they are expected to do.

If you plan to get a vaccine and are concerned, call ahead and ask the brand of the vaccine you are going to receive and then research it individually. If there is another brand that looks more appealing you can certainly ask your provider if it's possible to get that brand (they may not know it's available) or search for a provider who administers that brand.

I choose to be conservative about what I inject into mine and my children's bodies but I understand that science and medicine have their place. I will use them if I feel the need. And make no mistake about there the need is out there that can come calling at any time. If you choose not to monitor places like the CDC's website for information on diseases and track outbreaks then perhaps blanket immunization is for you. If you believe it's all a conspiracy of greed and control and that medicine does no good then that's your choice, too.