Nan Austin

Chasing immunity – vaccines, fears and moral dilemmas

With March come college basketball, green beer and, for those with 4- and 5-year-olds, kindergarten registration. To sign up, children need to show a record of inoculations, unless there is a medical reason they cannot be vaccinated, or if parents sign a statement that their personal beliefs forbid it.

A legislative move is afoot to eliminate that personal belief exemption, spurred in part by the Disneyland measles outbreak. Senate Bill 277 would eliminate the exemption and require public schools to notify parents of immunization rates. The notice would help parents of children who cannot be vaccinated, because of allergies or medical problems, avoid schools of higher risk. The bill is set for its first hearing April 8.

The Disneyland outbreak is a case study of how highly contagious diseases spread. One unidentified infected traveler who visited the park in late December spread a particularly virulent strain of measles, sickening 142 people in seven states as of March 6, according to a report by the Centers for Disease Control and Prevention. Measles is so contagious, the CDC says, the infection rate among unvaccinated people who are exposed is nearly 100 percent.

Measles, declared eradicated in the United States in 2000, is coming back. Worldwide, the disease is one of the leading causes of death among children, notes the World Health Organization. In 2013, measles killed 145,700 people, down from 2.6 million deaths a year before the vaccine became available in the 1980s.

Most of us who had the disease remember a high fever and red spots lasting one miserable week. But 1 in 10 who catch it will develop an ear infection that can lead to permanent hearing loss. Others will suffer blindness, encephalitis, severe diarrhea or pneumonia. More than 1 in 4 – 28 percent – of youngsters under 5 who catch the disease will have to be hospitalized.

Why would anyone choose to leave his or her child susceptible to such a dangerous disease and at risk of spreading the disease to others? For many, the answer is Dr. Andrew Wakefield.

In 1998, Wakefield led a published study of 12 case histories in which parents or the child’s doctor blamed bowel or developmental disorders on the vaccine against measles, mumps and rubella, or MMR. The study provoked widespread fear that the vaccine could cause autism and vaccination rates dropped.

In 2004, Sunday Times journalist Brian Deer did an exposé, calling into question Wakefield’s findings, financial motives and treatment of his subjects, saying autistic children were subjected to lumbar punctures and colonoscopies.

In 2010, Britain’s General Medical Council launched its own investigation. It found Wakefield guilty of dishonesty, ethical lapses and abuse of developmentally challenged children and stripped him of his right to practice medicine.

Cutting-edge research is now cataloging genetic disruption seen in people with autism, zeroing in on possible damage to the egg or sperm of a parent, according to an article in the January-February issue of MIT Technology Review.

The truth is no one knows what causes the amazing array of brain differences now called the autism spectrum disorder and there may be no single answer. Infants with some aspect of autism now make up 1 of 68 live births, but multiple large studies have found no link to vaccines.

The simple science is that vaccinations are linked to serious problems in 4 children per 1 million, while measles kills 1 or 2 out of every 1,000.

Still, parents worry. One mother who initially decided not to vaccinate her baby wrote a book about her internal conflict and personal research into the subject. In “On Immunity: An Inoculation,” author Eula Bliss puts forward that belief in the autism-vaccine link goes beyond science.

She explores her own wish to isolate her baby from harm, dissecting it in historic references to filth as causing disease and more recently as fear of toxins and pollutants. But purity ends even before birth, she notes.

“We are all already polluted. We have more microorganisms in our guts than we have cells in our bodies – we are crawling with bacteria and we are full of chemicals. We are, in other words, continuous with everything here on Earth. Including, and especially, each other,” Bliss writes.

She also excoriates her early belief that diseases happen to other people. Other people are at risk, for lifestyle choices or poor hygiene. That we all co-exist, for better or worse, she talks about in relationship to vaccines – not as a way to protect one child, but as a way to protect one another. Vaccination works, she explains, “by enlisting a majority in the protection of a minority.”

Healthy young people getting flu shots helps protect the elderly. Children getting vaccinated against rubella, which causes birth defects, helps protect pregnant women and their unborn children. Pertussis vaccines protect newborns.

The decision not to vaccinate, she argues, then involves a moral dilemma. “This puts the conscientious objector in the precarious position of potentially contributing to an epidemic,” Bliss writes.

The statistics of the grim diseases vaccines prevent are crystal clear. Those who choose not to vaccinate are assuming their children will not catch what were once every parent’s nightmares. This creates another moral hazard, because their assumption depends on the vast majority of children being vaccinated to protect them.

IMMUNIZATIONS

Many diseases that once threatened children with disabilities and death can now be avoided with vaccines. One is given shortly after birth, the rest at 12-15 months, with a second dose at 4-6 years old.

VACCINATION RISKS:

Allergic reaction (usually to gelatin or neomycin); Fever (1 in 5 children); mild rash (1 in 20); seizure from fever (1 in 2,500); temporary low platelet count (1 in 40,0000); deafness, coma, brain damage (recorded in 4 cases per in 1,000,000).

A single, widely publicized, study in 1998 linking autism to vaccines was declared a hoax, written by a doctor accused of having plans to profit from the scare.

DISEASE RISKS:

▪ Chickenpox (varicella) – Rash, can scar; risks include shingles later, brain damage, death

▪ Measles – Rash, cough, high fever; risks include seizures, encephalitis (1 in 1,000), death

▪ Mumps – Fever, headache, swollen glands, swollen testicles (1 in 5 male teens or adults); risks include deafness, meningitis (1 in 5,000), sterility

▪ Rubella – Rash; risks include arthritis, birth defects or miscarriage

▪ Diphtheria – Sore throat, swollen glands; risks include swelling of the heart, heart failure, paralysis, death

▪ HIB – Risks include meningitis, intellectual disability, epiglottitis cq, pneumonia, death

▪ Hepatitis – Fever, stomach pain, vomiting, jaundice; hepatitis A risks include liver failure, kidney, pancreatic and blood disorders; hepatitis B risks include liver failure, liver cancer

▪ Pertussis (whooping cough) – Long-lasting severe cough, pauses in breathing, whoop from gasping for air; risks include pneumonia, death

▪ Polio – Risks include permanent paralysis, death

▪ Pneumococcal – Risks include blood infection, meningitis, death

▪ Rotavirus – Diarrhea, fever, vomiting, dehydration

▪ Tetanus – Stiffness in neck, difficulty swallowing; risks include death

Source: Centers for Disease Control and Prevention, Mayo Clinic

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