Personal Perspectives—The Success of Vaccinations.

Dr. James Feist knows from experience the devastation that communicable diseases like measles or mumps can bring to a family and a community.

“When I was in training,” said Feist, a retired pediatrician in Gallatin County, “an entire hospital floor was filled with babies with meningitis, a brain infection that can cause deafness, affect learning, and ultimately could lead to death.”

Today, he said, that is no longer the case.  “There has been an incredible change,” Feist said, “because of vaccines.” Now most medical residents have never seen this disease.  “Many parents don’t realize how significant the number of illnesses in the U.S. have been reduced by vaccines,” Feist said.

The success of vaccines can’t be denied. Before vaccines were available, thousands of Americans died every year from diseases that are now rare.  One disease alone – pertussis – used to cause an average of 4,500 deaths per year in the U.S. Today, fewer than 25 to 30 people per year die from the disease, mostly very young children not yet old enough for the vaccine.  The same can be said of many other diseases, including measles, mumps, and diphtheria.

Unfortunately, the dramatic life-saving success of vaccines has been so resounding that some parents no longer perceive the diseases as a threat and are choosing not to use vaccines for their children. Misinformation about the safety of vaccines is helping drive this trend, and creating opportunities for diseases such as measles and mumps to make a comeback.

“A major issue driving people to bypass vaccines is, ironically, the success of the vaccines at preventing death and disease,” explains Matt Kelley, Gallatin City-County Health Officer. “Many people just do not believe that these diseases pose a realistic health threat—they don’t know anyone who’s had measles or polio or diphtheria.”

But the decision to bypass vaccines, Kelley said, increases the risks of future outbreaks, illnesses, and deaths.

The recent outbreak of mumps in Belgrade demonstrates the benefits of vaccines, and the risks associated with the decision to bypass vaccines.  The Belgrade mumps outbreak, while serious and concerning, has been limited in scope to a large extent because of vaccines and infection control measures implemented by public health officials and school staff.  When the first cases were identified, school nurses quickly identified students without the mumps vaccine who were most vulnerable to catching the disease.

Local health care providers, particularly Community Health Partners, worked quickly and collaboratively to provide services to families. Public health nurses spent hundreds of hours communicating with parents, administering immunizations, and implementing control measures recommended by the U.S. Centers for Disease Control & Prevention.

All three of the Belgrade schools affected had very high vaccine coverage rates; if that number had been lower, there probably would be more cases. Without vaccines and infection control measures, outbreaks such as the one in Belgrade likely could result in dozens, if not hundreds of sick children.  With that rise in cases, comes increased risks for potentially life-threatening complications such as encephalitis and meningitis. And by limiting spread of the disease, health officials are able to protect the most vulnerable among us – babies, cancer patients, and others with weak immune systems – who are most likely to have severe complications.

This is not to downplay the seriousness of the outbreak.  Students missed significant time from school.  Parents missed work.  Resources were re-directed to manage the situation, sapping capacity (staff hours, clinic hours and money) that could be used to deal with other pressing issues. Hundreds were needlessly put at risk from a disease that is preventable.

Before and After

Before the measles vaccination program started in 1963, the CDC estimates that roughly 3 to 4 million people in the U.S. contracted measles each year. Of those people, 400-500 died, 48,000 were hospitalized, and 4,000 developed encephalitis (brain swelling) ².  By 2000, the U.S. declared that measles was eliminated from this country, thanks to widespread use of the measles vaccine.

“What’s concerning is we are starting to see a re-emergence of diseases such as measles because people are making decisions not to vaccinate,” said Kelley.  In 2014-15, we had over 850 cases of measles reported in the U.S. during a large, multi-state outbreak linked to an amusement park in California. The outbreak likely started from a traveler who became infected overseas, then visited the amusement park while infectious, explained Kelley.

The fact is, while the U.S. has done an exceptional job at eradicating many communicable diseases, other countries have not and the only way to keep these types of disease from returning is to vaccinate.

Dr. Paul Offit, a pediatrician with the Children’s Hospital of Philadelphia, illustrates the point.  “In the measles outbreak in San Diego that occurred a few years ago, that is exactly what happened. The mother didn’t vaccinate her children, and then took her children to Switzerland. The 7-year-old got measles, came back, and was sitting in the waiting room. The mother didn’t know what it was. She had never seen measles before. The child had fever and a rash, and was exposing everybody else in the waiting room. Three of the children in the waiting room were less than 1 year of age and hadn’t yet been vaccinated. All were severely infected with measles, were admitted to the hospital, and one almost died. The mother of the child who almost died said, ‘She made a decision for me.’ Did she have a right to make that decision?” http://www.medscape.com/viewarticle/822981#vp_3

The Child’s Best Interest

“There is a significant amount of misinformation out there,” Dr. Feist says. “As a result, people read it and become convinced it is a fact. They then make decisions about the health care of their children based on poor data.” He goes on to say, “We spend lots of time trying to educate people properly. It makes no sense for us to push vaccines unless it’s helpful. When you look at the big picture, infectious diseases were a big problem and we’ve resolved that.”

Still, there is a small segment of the population harboring fears over vaccinations.  Some parents continue to voice concerns about a non-existent link between vaccines and autism.  The concerns persist even years after the only study claiming a link was retracted and its author lost his medical license after a regulatory body determined that he falsified data in the study.   “The study has been totally and unambiguously discredited,” said Kelley, “and still we hear concerns about it.”

Dr. Feist relays a story of taking care of a 12-year-old with a brain infection related to the measles virus. Due to a belief that vaccines were harmful, the parents had purposely decided not to vaccinate. The child was in the hospital for a couple of months but the brain was ultimately destroyed by the virus and the child died. This type of story is devastating for doctors who know that these diseases are preventable.

Dr. Kristen Feemster, pediatric infectious disease physician and researcher at the Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine explains, “We have more cases of whooping cough in the past few years vs. the past 50 years. The barriers created by vaccination are eroding as more and more people are delaying immunizations. Parents say, ‘It’s my parental right to raise my child as I see fit.’ But who represents the child’s best interests?”

Many doctors use the use of car seats as a good example. Would you put your child at risk of injury without the safety of a car seat?

Not Just for Kids

Adults aren’t out of the woods when it comes to vaccinations. Certain vaccines are relevant later in life and shouldn’t be overlooked.

Pertussis vaccine is very important for parents, grandparents or any other infant caregivers. All pregnant mothers should be vaccinated in the third trimester. If they aren’t, the hospital will ensure it happens before leaving. Vaccinating close family members and baby’s caregivers will give the infant better protection; this is called “cocooning.”

Measles, Mumps and Rubella (MMR) vaccine is also important, not just for the protection of children, but for adults as well. Mumps can cause sterility in males and complications from measles can be severe. The MMR vaccine requires a booster, so if you are unsure if you have had both doses, talk to your health care provider.

HPV and Hepatitis B. HPV, originally thought to only be for girls in preventing cervical and uterine cancer, is also recommended for boys to prevent genital warts, oral, anal and penile cancers and helps prevent the spread of the virus to their partners. The HPV vaccine can be given up until age 26. Hepatitis B is important for anyone traveling internationally, and if your job exposes you to blood, it’s prudent to get the vaccine.

The Big Picture

Matt Kelley lends insight on the bigger picture.  “Leaving children unvaccinated unnecessarily puts people at risk; the more cases we have the more likely we will have serious and life-threatening complications. There is a great community good that comes from vaccines.  Your decision to be immunized protects the most vulnerable among us: the boy in the classroom with leukemia, the lady next door going through chemotherapy, or the child at daycare with asthma or other pulmonary diseases. Keeping your children immunized helps not just them, but those who can’t be immunized.”

A great example of this is the success of the Rubella portion of the MMR vaccine, which has almost eliminated Congenital Rubella Syndrome, a devastating infection that pregnant mothers get and pass on to their babies. While Rubella in a 5-year-old is pretty mild, if a child gives it to a pregnant mom, it can be passed on to the fetus. Giving a pre-school child this vaccine protects the mother, teacher or pregnant lady sitting next to you on the bus. A healthy community does things for the good of everyone.

A Personal Perspective

It’s easy to explain the rationale behind vaccinating, but living with the death of a loved one, particularly a child, is anything but easy.

Daniela Lopez-Morales, Public Health Nurse tells her own family’s story…

My mom’s older sister, Columba, got sick with diphtheria in 1969 when she was 6 years old.  After I started working as a public health nurse, I asked my mom to tell me this story and to share how she processed the loss of her sister at such a young age (5 years old.)

As her sister was dying, my mom was getting in a car with one of her aunts to be taken to the city’s hospital two hours away since she was starting to show the same symptoms my aunt had shown earlier. All she can remember is hearing from another family member that Columba was gone. With tears in her eyes, she told me of how confused she was when she went back home; she did not quite understand where her sister was and continuously asked about her.

My aunt and mom were not the only ones to get diphtheria during this outbreak. Many kids had not been vaccinated– not because their parents refused the vaccines, but because they lived in a very rural area and vaccines had not been taken to their community. After my aunt’s death, public health officials came into their town and vaccinated all the kids in the community, promptly ending the outbreak.

My grandma and my grandpa lost a daughter that year, and my mom lost her older sister. More than 46 years later, my grandparents still miss her. Just last Christmas, my grandpa asked out of nowhere, “What would she look like today? She would probably be just as beautiful as my other daughters.”

I’m very proud of the work that I do at the Gallatin City-County Health Department. Every time I give a shot, I think of how easy it would have been to prevent her death. With my work in immunizations, I know that I am preventing the loss of another daughter, another sister.

¹ Roush SW, Murphy TV. Historical Comparisons of Morbidity and Mortality for Vaccine Preventable Diseases in the United States. JAMA 2007; 298(18):2155-2163

² http://www.cdc.gov/measles/about/faqs.html

³ http://www.cdc.gov/measles/about/faqs.html