OP-ed: Delay in vaccinations a cause for concern

In recent years, Alaska’s immunization coverage rates for infants age 19–35 months have been among the lowest in the nation. In 2009 Alaska ranked 49th out of 50 states; in 2010 we bumped up slightly to 42nd; and in 2011 we bumped up again slightly to 39th. Despite this slow but steady trend in the right direction, a recent study performed by the Alaska Division of Public Health indicated that more Alaska mothers have been choosing to delay or decline vaccines for their children. This is alarming and unfortunate.

Vaccines are among the most effective and safe public health interventions available to prevent serious disease and death.

Before polio vaccine was available, 13,000 to 20,000 cases of paralytic polio were reported each year in the United States.

Before measles immunization was available, nearly everyone in the U.S. got measles, and hundreds died annually from the infection.

Prior to pertussis (whooping cough) immunization, between 150,000 and 260,000 cases of pertussis were reported each year in the United States — mostly among young children — resulting in up to 9,000 deaths annually.

Health care providers who vaccinate young children follow a schedule prepared by the U.S. Advisory Committee on Immunization Practices, a group of medical and public health experts. The current schedule is timed to protect children from 14 diseases by inoculating them at the time in their lives when they are most vulnerable to disease.

Much of the fear about vaccines is still due to concerns about autism — this is a groundless fear that arose from a spurious study published in 1998 in The Lancet, a British medical journal. The article was dismissed in 2010 as “irresponsible and dishonest” and retracted from the journal. Numerous powerful studies published subsequently have shown no correlation between vaccines and autism.

Reasons commonly cited for not vaccinating include:

■ Fear about safety

The most comprehensive examination of the safety of the U.S. childhood immunization schedule to date was released by the Institute of Medicine in January 2013. The researchers found no evidence that the schedule was unsafe, and underscored that delaying or declining vaccination has led to outbreaks of vaccine-preventable diseases.

■ A belief that too many vaccines overload the immune system

Another recent large study published in Pediatrics concluded that multiple vaccines do not overwhelm or weaken children’s immune system. Young infants have an enormous capacity to respond to multiple vaccines, as well as to the many other challenges present in the environment.

■ Belief that the risks outweigh the benefits

Risks: Any vaccine can cause side effects. For the most part these are minor (redness/sore arm, low-grade fever) and resolve in a few days. The risk of a severe reaction to a routine childhood vaccine is extremely low.

Benefits: Due to vaccines, there has been a 74 percent to 100 percent reduction in cases of all 14 of the childhood vaccine-preventable diseases in the U.S. Due to the high rates of international travel in our population, the only thing preventing these diseases from quickly coming back to our doorstep is immunization.

■ Belief that parents can rely on “herd immunity”

Herd immunity is a situation in which a sufficient proportion of the population is immune to an infectious disease, making epidemics unlikely. Again, infectious diseases are brought to Alaska from faraway places every day, so relying on herd immunity to protect a child is extremely risky. A small drop in the proportion of the population that is immune to many diseases results in a substantial increase in the risk of outbreaks. Alaska’s current pertussis epidemic — and recent pertussis-related infant death — underscores the danger of relying on herd immunity.

Parents and clinicians should study the most dependable scientific evidence available before considering not to follow the national childhood vaccination recommendations. The overwhelming body of scientific evidence clearly indicates that the current recommendations are safe and carefully timed to minimize unnecessary suffering and death in our children. Learn more at: www.cdc.gov/vaccines and www.chop.edu/service/vaccine-education-center/home.html.

Vaccinating is an issue of both personal and social responsibility. When we vaccinate our children on-time, we protect their health, and the health of our community.

Joe McLaughlin, M.D., M.P.H., is the State Epidemiologist for the Alaska Section of Epidemiology.

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