|
medpundit |
||
 |
 |
|
Saturday, November 30, 2002Eighteen percent of Vashon Island's 1,600 primary school students have legally opted out of vaccination against childhood diseases, including polio, measles, mumps, rubella, diphtheria, whooping cough, tetanus, hepatitis B and chicken pox. The island is a counterculture haven where therapies like homeopathy and acupuncture are popular, and where some cite health problems among neighbors' children that they attribute to vaccinations. The nationwide average for dropping out of vaccines is around two percent. Most of the parents interviewed in the article are well-off, all of them seem to be well-educated, yet they've rejected one of the most successful public health programs we have. Before immunizations were routine, pediatric wards were full of children in iron lungs who couldn't breathe on their own thanks to polio. When I was in training, older physicians used to tell horror stories of children gasping for their last breaths as pertussis (whooping cough) closed up their airways, and there was nothing they could do to stop it. Measles used to be a significant cause of blindness and deafness. Congenital rubella caused all sorts of birth defects. The success of the immunization programs against these highly communicable diseases have wiped them from our collective memory. Now, the vaccines seem worse to many than the diseases. (Same as smallpox, no?) Some of the parents explained why they made their choices: Vaccine resisters cite an array of reasons. "Sometimes it's distrust in government, feeling it's in bed with the vaccine industry and `everyone's making money off our kids,' " Mr. Salmon said. Sometimes the objections are religious, as among Christian Scientists and some Amish congregations. Sometimes a community is scared when a child is truly harmed by side effects; the live polio vaccine, for example, is thought to cause about eight deaths a year. Some parents are upset at the sheer number of injections a child must get — usually about 20 by age 2. Others are convinced — despite evidence to the contrary — that vaccines are highly likely to cause severe health problems, like seizures and autism. ..."I consider well-baby care to be a capitalist plot," Maryam Steffen, a mother of four said only half-kidding. Then there are those who have more confidence in their own bodies than in medicine: ...Ms. Forest's grandson Deven had whooping cough two years ago and, she conceded, probably passed the disease to 10 other children, including an infant. "Yeah, that bothered me," Ms. Forest said. "But I called everybody and we studied up on what you can do to build up the immune system." The baby "did just fine," she said. "On Vashon Island, you have middle-class people who eat healthy and keep warm. If everyone was poor-poor, not breast-fed, not eating right — that might be a reason to vaccinate." But she and her daughter remain steadfastly opposed. They were lucky. There was one mother on the island, however, who changed her mind after facing whooping cough in her infant son: "My son would turn all shades of purple," she said. "He stopped breathing several times and we took him to the hospital. My daughter was terrified of going to sleep because then it got worse. She would vomit all over the place. My husband cracked ribs from coughing." Now, Ms. White said, she would advise other mothers to vaccinate against whooping cough, polio and tetanus, but only with the newest vaccines. She still has not vaccinated Julian, now 3, against measles, mumps, rubella or chicken pox. I have no statistics to back this up, but it’s been my impression that there’s been a growing wariness about vaccines since we’ve expanded childhood vaccinations to require immunizations against diseases that are either not all that easily communicable, like hepatitis B, or that aren’t all that dangerous, such as chickenpox. There was resistance to universal adoption of these vaccines within the practicing physician community as well, but it was over-ridden by the academics who make up the advisory panel on immunization practices and the professional societies. I remember sitting in conferences when these recommendations were being put forth - conferences designed for pediatricians, and conferences designed for family physicians. There was always very vocal dissent from the audience during the discussion sessions. Hepatitis B would be put to better use if directed at at-risk populations - healthcare workers, sexually active teenagers, IV drug users. It made no sense to add three more shots to an infant’s regimen when they may never grow up to be at risk. Chickenpox was an inconvenient, but not life-threatening illness. The immunization itself could cause a mild case, and there were reports of kids getting shingles from it. Besides, no one could say with any certainty how long the immunity from the vaccine would last. What would happen when kids grew up, their immunity to the virus waned, and they got chickenpox? It’s much more dangerous in an adult than it is in a kid. What if those adults were young and pregnant, the worse-case scenario? The counter argument from the lecturer would always be that the hepatitis B vaccine was the first chance to immunize against cancer (liver cancer, a complication of hepatitis B infection), no one could predict what a kid would grow up to be like, and that a small percentage of hepatitis B patients have no idea where they could have gotten it. For chickenpox, it was that the vaccine has been used in Japan for twenty years, and so far they hadn’t seen an increase in adult cases, that a small minority of children developed bad skin infections from scratching their rash, and besides, what about the small chance that a child could develop a weakened immune system either from cancer or from cancer treatment, and then get exposed to chickenpox? Immunizing everyone would protect these kids from a life-threatening illness. So, the rest of us went back to our practices and started the difficult job of selling these immunizations to our patients. It wasn’t an easy task. Parents had the same doubts and reservations that my colleagues and I had. I’m still not that enthusiastic about either hepatitis B or chickenpox vaccines. Hepatitis B immunization is now required for public school attendance in my state, (and forty-two others) but it was a requirement that came about after heavy lobbying by Smith-Kline, the company who manufactures it. The mandatory requirement was also supported by physician groups, but it left people wondering if there wasn’t some sort of financial collusion between the doctors and the vaccine industry. (For the record, I don’t believe that to be the case. I think those physicians who advocate them sincerely want to eradicate as many diseases as possible.) I have to confess, though, I often wondered the same thing as I sat in those conferences where just outside the assemblyroom stood lavish displays by vaccine producers. The most important immunizations remain those against the highly communicable and dangerous illnesses - polio, whooping cough, diphtheria, tetanus, measles, rubella, and haemophilus influenzae. If parents are wary of immunizations, it’s those I try hardest to sell them on. UPDATE: A reader emailed these observations about Vashon Island: It seems to me the Vashon Islanders, and others, who eschew vaccinations exhibit a class and cultural elitism that rides on the back of the vast majority who practice responsible public health--I wonder if they would be so confident of their children's immune system if they were transferred to S.E. Asia, Africa, or if the majority of residents on the Island did not vaccinate their children--by the way--what happens to children who are not vaccinated, grow up, travel the world, and are exposed to these diseases as adults? What happens is they're more likely to catch those diseases. Even if those families were transported to parts of the world without high immunization rates with their health and wealth intact, their immune systems would be pitifully prepared to fight those disease naturally. The whole idea behind immunizations is to give the body's natural defenses a boost to help them ward off disease. If our systems were perfect, there wouldn't be any disease in the first place. posted by Sydney on 11/30/2002 12:19:00 PM 0 comments 0 Comments: |
|
