Vaccines, preventable disease, and the nature of risk

Two nights ago, I was watching, with my family, an old episode of Dr. Quinn, Medicine Woman, in which a young woman is bitten by a rabid wolf, develops rabies, and dies. That same night, I read a post on Facebook decrying the dangers of immunizations, with a link to an online “news” article blaming immunizations for everything from spreading cancer to HIV.

My mother, as a girl, was bitten by a rabid dog. She was treated immediately with a series of injections of anti-rabies vaccine to prevent her from developing the disease. Rabies, once symptoms develop, is nearly 100% fatal. In Dr. Quinn’s time, there was no vaccine. In my mother’s time, the vaccine she received saved her life (and thus my own).

While most children are not immunized against rabies, they are routinely immunized against an increasing number of diseases. Some of these used to be called “usual diseases” of childhood, such as measles, an acute viral illness which can lead to permanent brain damage, pneumonia, and death, and which can be prevented by immunization. However, when people stop getting immunized, measles returns. According to the Center for Disease Control (CDC) website, we could expect 2.7 million deaths from measles if immunization were stopped.

For every disease that is preventable using vaccines, there is a similar story. I remember, as a child, knowing that parents all over the country were terrified of polio, which could cause severe paralysis and death. I remember putting dimes in slots on a card for the March of Dimes, a nationwide effort to fund research into preventing polio. Polio vaccine came as a miracle, and people rushed to receive it.

Other vaccine-preventable diseases, such as pertussis (whooping cough), can be found closer to home. It is most dangerous to young infants under 1 year old. According to the CDC, 1 in 5 infants get pneumonia, 1 in 100 have seizures, half stop breathing, 1 in 300 have encephalopathy (inflammation of the brain), and 1 in 100 will die.

There are people who do not immunize their children. They believe that immunizations are dangerous, and do not want to take the chance that their children could be harmed. They believe that it is too great a risk.

All of us live with risk. We do not know with certainty what will happen. Every day, we choose what risks we are willing to take. Most of the time, we do so without really thinking about it. Many of our choices are automatic and habitual. We simply do not recognize much of the risk we navigate daily.

As parents, it is in our biology to protect our children from risk, and we must decide how to protect them. Our decisions are based on what we learned from our own parents, friends, reading, research, feelings and emotions.

Frequently lacking, however, in our decision-making, is the study and understanding of history. Edmund Burke said “Those who don’t know history are destined to repeat it.” He could have been talking about vaccine-preventable diseases.

Today’s parents of young children grew up themselves in a time when many of these diseases were rare by virtue of the fact that their generation was immunized. Unlike me, they do not remember polio, measles, or diphtheria. These parents do not understand the risk that they are accepting on behalf of their children.

In truth, vaccines, like everything, are not without risk themselves. However, the risks of the vaccines that we use today are proven to be very small.

Vaccine-preventable diseases all carry much greater risk of serious illness and death, than vaccines. And if we stop immunizing, they will be back to threaten our families.

It is also important to consider risk to the community. As people travel all over the world, they carry illness as unseen baggage. And at home, your non-immunized child can give pertussis to the infant next door. Your child, who is now a teen, could get very ill, but your neighbor’s baby could die.

The community is protected by something called herd immunity. If enough people in the community are immunized, there is less chance for disease to take hold and spread. It is contained by all those people who don’t become ill, but only if most people have been immunized. Ultimately, this is how smallpox became eradicated all around the world.

To make decisions about risk in the present, we must learn the events of the past. We must understand and consider risk vs. benefit, and that we choose risk for others besides those in our own families. In planning for the present and the future, it is vitally important that we choose risk in a way that benefits people around us in addition to ourselves and our children.

Danielle Rosenman is a former family physician and founder of medical counseling practice. She blogs at 5 Cents: The Doctor is In.

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  • http://twitter.com/SarahWW Sarah Wells

    There is middle ground, you know.  Vaccine schedules can be altered,   some vaccines delayed or deferred.

     Some vaccines, such as Hep B, can be delayed without serious short-term public health consequence- although it does leave persons at risk of transmitting it through negligence (eg, failing to maintain disinfection and sanitations standards ) more exposed to lawsuit or rebuke from oversight entities.

    • Danielle Rosenman

      Immunizations are sometimes delayed because of parental anxiety.  By compromising with the parent, we can often get them to have some of the immunizations and leave the door open to adding immunizations at subsequent visits, and there are times when this is the best that can be done.  This is far from ideal, however, as children can be exposed at vulnerable ages, and also the provider can lose track of the alternative schedule.  Either way, the child can end up unprotected.

  • http://www.facebook.com/susan.v.wallace Susan V Wallace

    I’ve heard your argument before: it’s about weighing risks, it’s about herd immunity, etc. It’s the case being made by most of mainstream medicine. I’ve also heard the other side of the argument, and struggle to reconcile the facts/research I see asserted by both sides.  I wonder if you could address the decline of disease prior to vaccine introduction in a future post?  I’m a parent trying to get a good picture, but I’ve yet to see a ‘mainstream medicine’ respond to this issue. Charts can be found here: http://theatlasoflife.com/2010/06/08/natural-disease-decline-immunization-effectiveness-and-immunization-dangers/ among other places. I’m sincerely interested in the response, and would appreciate it greatly. I’m sure other parents trying to muddle through the mess of information would also appreciate it.

    • Danielle Rosenman

      Of course, you, as a parent, want
      to do what is right for your child.  If
      these diseases had been significantly declining, there would not have been the
      historical drive to develop and provide vaccines for these them.  It is easy to be mislead by charts of
      statistics, especially when they are posted without explanation, and when you don’t know the sources of the “data.”  In fact, many of these diseases come
      in cycles, ranging from more prevalent to less prevalent.  A reliable
      article that may interest you can be found here: http://jama.ama-assn.org/content/298/18/2155.full
      .  This article includes a chart of
      prevalence, from the 1930′s to 2006, of cases and deaths for a number of vaccine-preventable diseases,
      and it is extensively annotated with specifics.  Looking at present time information from countries with lower immunization rates, the World Health Organization reported that 1.7 million children under
      the age of 5 died from vaccine-preventable diseases in 2008, around the world.  The key word, here, is “preventable.”  Since so many children around the world are
      not immunized, it shows us that even today, if children are not immunized, they
      are at risk for preventable death.  The
      risks of vaccines are very small, in comparison.  Sometimes, by not doing something, we are exposed to the greatest risk. I hope this
      has answered your question.

  • http://www.cinnamonagency.com jas_cinammonagency

    The number of new diseases is growing every day, some easy to shift, others not so easy or even with names yet!

    To vaccinate against everything would be impossible, but those who do not immunize are fools!

  • Anonymous

    Again, those who have never seen a loved one die of polio, a child develop profound deafness because of meningitis, or a baby turn blue from a coughing fit because of pertussis, or see a young teen with hundreds of venereal warts and lifelong scarring (because of a rape),  may never understand the benefit of vaccines.  I will continue to do the right thing and contribute to herd immunity by encouraging timely vaccinations.

  • http://profiles.yahoo.com/u/66NCFAXDWYB7JVNVNLNIUTCUVU Violetta V

    Excellent post! My mother when she was young had Diphtheria. Both her and her mother got it. They were in  a hospital. This was in Russia, so many people were in the same ward. In the same ward there was a mother with a little girl. The girl was sick, the mother was there with her. The girl survived as did my mother and grandmother. The little girl’s mother caught the disease from her child and died.

    I remember watching movie “Interrupted Melody” about Marjorie Lawrence who was an opera singer, a famous Wagnerian soprano. In 1941 when she was 34 she caught polio that left her with both legs paralyzed.

    When we read 19th century literature we read about child mortality, infectious diseases that kill children. Today there is so little knowledge of history. People just don’t understand.

  • Minority View

    In your article you cite some statistics. I’d appreciate citations for these. Here are two that stood out for me: “It is most dangerous to young infants under 1 year old. According to the
    CDC, 1 in 5 infants get pneumonia, 1 in 100 have seizures, half stop
    breathing, 1 in 300 have encephalopathy (inflammation of the brain), and
    1 in 100 will die.” You do say “according to the CDC” but I’ve found considerable variation in the stats from the CDC, with the parent’s pages differing quite a bit from the info in the Pink Book. A link to the actual source would be helpful.

    Another one: ” According to the Center for Disease Control (CDC) website, we could
    expect 2.7 million deaths from measles if immunization were stopped.” Link?

    This also doesn’t include a time period. One year? Ten years? Or a geographical expanse. U.S.? The entire planet? It seems unlikely to be the US as the death rate from measles during the 1950s (vaccine became widely available in 1967) was 400 to 500 per year. Bad enough, but certainly not comparable to 2.7 million.

    Finally, in one of the comments below you say: ” the World Health Organization reported that 1.7 million children under the
    age of 5 died from vaccine-preventable diseases in 2008, around the
    world.  The key word, here, is “preventable.”  Since so many children
    around the world are not immunized, it shows us that even today, if children are not immunized, they are at risk for preventable death.”

    This treats the entire problem as though the only reason for an excess of childhood deaths is the lack of vaccines. Poor living conditions, malnutrition, dirty water, lack of basic medical care all play a role. If a malnourished child dies of mumps, was it the mumps or the malnutrition that killed the child? And if you keep children from dying from childhood illness, but leave them living in horrendous conditions, will they grow up to healthy productive citizens? Will they grow up at all?

    I recommend this excellent article on the role of vaccines in reducing mortality in the U.S. http://www.columbia.edu/itc/hs/pubhealth/rosner/g8965/client_edit/readings/week_2/mckinlay.pdf

    Thank you!

  • http://trevor.dekoekkoek.net Trevor de Koekkoek

    “And at home, your non-immunized child can give pertussis to the infant next door”  True.  And your vaccinated child can also give pertussis to the infant next door.  And both can do it whether symptomatic or not.  Your point?