Friday, May 18, 2012

Childhood Vaccines: A Case of Collective Amnesia

Children in Nigeria line up to receive the smallpox vaccine, 1968.
In 1979, the World Health Organization (WHO) declared
the global eradication of smallpox and recommended
that all countries cease vaccination. 
Source: CDC
Not long ago, I was in the bleachers at one of my son's baseball games. It was one of those ordinary, and therefore quite wonderful, evenings. Nice weather, decent sports action, no place I'd rather be. Out of the corner of my eye, I saw a dad and two kids walk by and then stand by the bleachers to watch the game. Again, not unusual. However, what caused me to do a double take was the oldest child's extreme skin condition.

All of this child's visible skin was covered with angry-looking, red sores. Arms, hands, face, neck. The sores looked vaguely familiar, and then it hit me: This kid was walking around with chicken pox. Not trusting my own diagnosis, I leaned over to a physician/baseball mom near me and said, "Does that kid have chicken pox?" She nodded her head in affirmation and said, "I know his family. They don't vaccinate, and they infected him on purpose at a 'chicken pox party'."

I had to think about that for awhile.

From what I could tell, most of the kid's pox were scabbed over, which meant they weren't infectious. But I did notice some newer pox that looked more like blisters, meaning that they were potentially infectious. Even though I confess to a somewhat irrational cringe moment at being so close to this kid, I wasn't really worried about my own health. After all, I had a raging case of chicken pox in elementary school that rendered me immune. But looking around the bleachers, I saw a couple of grandparents and a baby. And that's when my noncommittal response to the chicken pox family turned into a more judgmental one. After all, the grandparents were at risk of developing chicken pox or activating shingles because of their aging immune systems, and the baby was definitely at risk because the chicken pox vaccine is not given until four or five years of age. And for all I knew, any one of the seemingly healthy middle-aged parents in attendance could have been immunocompromised from cancer treatment, HIV infection, or other conditions. Whatever thoughts I had about the chicken pox family's beliefs toward vaccination quickly became secondary to what I thought of this family being in a public venue with a perhaps-active and easily transmissible infectious disease, no matter how "certain" they were of the child's infection status.

Unfortunately, judging from vaccination trends, we can expect more and more of these exposures.

This past week, media outlets across the country carried news of the whooping cough outbreak in Washington state. The outbreak is huge - well over 1,000 cases, and one that

"could surpass the toll of any year since the 1940s, before a vaccine went into wide use," according to public health officials interviewed by The New York Times. 

The numbers are probably higher because many people with mild disease do not get a diagnosis. Further, the state is so strapped for cash that it is recommending foregoing the $400 diagnostic test and just prescribing antibiotics to those with the hallmark symptoms and exposure patterns, causing speculation that only 1 in 5 infections are being recorded.

The outbreak is directly attributable to that fact that families of 6% of school-age children in Washington have opted out of some or all of the recommended immunizations. That 6% is over the tipping point where even people with some degree of immunity through vaccination can have elevated risk of getting the disease. This is especially germane to whooping cough. Researchers have reformulated the whooping cough vaccine in recent years to reduce its side effects. As a consequence, the new vaccine is not as effective as older versions were, making the concept of herd immunity even more important for this particular disease.

In other words, individuals who received vaccinations and trusted others to do the same in order to keep herd immunity strong, were totally screwed over by families who decided to not only put their kids at risk, but also other people's kids (and grandparents, and so on).

I've written about this issue before, from an international perspective here and a link to a vaccine expert here. It is so concerning that we are exiting, voluntarily, the era of disease prevention through vaccination. Not because the vaccines don't work. No, modern vaccines work extremely well. So well, in fact, that younger generations do not remember how deadly or disfiguring certain diseases can be because they have never experienced them. If vaccination rates continue to slide, though, it's fairly clear that we all - regardless of our own vaccination status - will pay the price, either through disease or higher health care costs.