By now you have probably heard about the measles outbreak that occurred in early 2015 which started with an infected person at Disneyland. This was a huge crisis as measles is very dangerous, is extremely contagious and the outbreaks are a public health nightmare. The reason the outbreak occurred was due to decreased vaccination rates against measles with the measles, mumps, rubella vaccine called MMR. An unethical and completely discredited study released by Andrew Wakefield is what scared parents into thinking they should skip the measles vaccine. It has since been disproven over and over and over again by extensive and appropriate scientific research. The original “study” was not scientific and an outright lie and Wakefield was paid off by a lawyer to do it. A description of Wakefield’s fraudulent behavior can be found here. But, the damage is done. So now I am left having many conversations about the safety and efficacy of vaccines. Until this outbreak, parents never really worried about a lot of these diseases because of vaccines. A product of our own success! Now everyone really needs to consider the repercussions of their choices.
Before reading my typical responses to common parent questions, please read Becoming a Doctor. I believe this insight into my background will help you understand my perspective on this issue. At no point in that post do I report ever being given kickbacks from pharmaceutical companies or being brainwashed. Again, my responses are based on medical evidence and experience.
#1 I’m worried my child will get too many shots at once. Doesn’t it overwhelm the immune system?
The awesome thing about our immune system is it is growing constantly in order to keep us free of infection. It can not be overwhelmed in an immunocompetent child. Everything your child breathes, eats and touches is stimulating the immune system to fight the germs and make memory cells. This is how we stay healthy in a germ infested environment and how we get less infections as we get older. When exposed to germs, the immune system recognizes proteins on the surface called antigens and forms attack cells against them. These attack cells are sometimes stored as memory cells to prevent infection in the future. The number of antigens in the entire series of vaccines is a tiny drop in the bucket compared to all of the antigens children are exposed to daily. I compare it to building an army. You don’t want your army to attack without growing and being trained. The series of vaccines are training the immune system to attack.
Interestingly, there is something called the Hygiene Hypothesis that theorizes an immune system that has not been challenged by exposure to every day germs is more likely to turn against you. That means more allergies and asthma and other autoimmune diseases in the future if you were never exposed to germs as a child. Therefore, don’t sweat it when your child eats off the floor!
#2 What about all of the ingredients in the vaccines? Should I be worried about mercury?
The vaccines are made to introduce antigens that will stimulate the immune system. In order for that to take place, adjuvants need to be used, otherwise the vaccine will not do it’s job. Furthermore, the vaccines need to be free of contaminants, so a careful process of sterilizing the vaccine is done. This leaves traces of ingredients that may sound scary but in tiny doses are very safe and are usually found in larger doses in our environment and food supply. A complete list of vaccine ingredients is available on the Centers for Disease Control website with an explanation into the necessity and safety of each ingredient. As for thimerosal, the mercury containing preservative once used universally in vaccines, it is no longer found in vaccines given to children under 3 years of age and was only removed as a precautionary measure. It is broken down into ethylmercury which is easily excreted from the body and in small doses has never been proven to cause any disease. This is different from methylmercury found in the environment like in certain fish. Of note, thimerosal was never present in the MMR vaccine.
#3 Should I split up the shots or follow the schedule?
The vaccine schedule is set after rigorous testing for safety and efficacy while also considering when children are most vulnerable to disease. There is good data that following the recommended schedule does not increase the risk of adverse events compared to going off schedule. Furthermore, staying on schedule protects your child from disease. As far as pain, there is also data that suggest the initial injection causes a stress reaction but each further injection does not. The stress reaction remains constant. That means 4 injections at once is one stressful event compared to 4 stressful events if they were given at 4 separate times.
#4 Aren’t vaccine preventable diseases rare and aren’t I protected by Herd Immunity?
No and no. Vaccine preventable diseases are endemic in other parts of the world and are a plane ride away. We see that from the Disneyland measles outbreak. Furthermore, as more people follow fear as opposed to doctors and scientists, there are fewer kids vaccinated in certain communities. That means herd immunity, the idea that we protect each other by staying vaccinated, is broken down. Imagine a brick wall surrounding a community that may include people who are unable to be vaccinated or who are too young. This community may also include vaccinated individuals in which their vaccine did not provide 100% protection or their memory cells have decreased. The brick wall is made up of citizens who are vaccinated and protected. Now, imagine holes in the wall that represent people who decide not to get vaccinated. The diseases sneak in and make their way through the community and can infect the most vulnerable citizens, including newborns and immunocompromised individuals. Vaccinating your child is not only important for your family’s health but for the health of your community.
#5 I heard vaccines cause autism.
NO THEY DON’T. THIS HAS BEEN PUT TO REST.
In conclusion, it’s important to look at the risk benefit ratio. Nothing is 100% and nothing is without risk. What we know is that the risks of vaccinating are very low (common side effects include pain at injection site or fever) and the benefits are astronomical (no life altering or life threatening disease!). It is clear that vaccines are the single most important discovery of our time. They save lives, plain and simple. No amount of sleep, exercise, fresh air or organic food (while a very healthy lifestyle) will create the memory cells in your immune system that fight infection. You will still get sick if exposed. Furthermore, a large portion of children in this country don’t have the luxury of safe outdoor space to play or organic food. So in the end, with the benefits far outweighing the risks, vaccinate to protect yourself, your children and your neighbors.