Yale University. US: A recent measles outbreak has sparked anew a long-simmering debate
about the safety of common childhood immunizations. YaleNews turned to
expert Dr. Marietta Vazquez, associate professor of pediatrics at Yale
School of Medicine, for an update and her take on the controversy, which
has caused the Centers for Disease Control and Prevention to issue a
health advisory to providers, and even President Obama to express his
support for vaccines.
What is the cause of the recent measles outbreak?
The
United States is currently experiencing a large, multi-state outbreak
of measles linked to cases reported at DisneyLand in California. As of
last month, 102people from 14 states are reported to have measles.
The current outbreak
likely started from a traveler who became infected overseas with
measles, then visited the amusement park while infectious. However, no
source has been identified.
Travelers bring measles in the
country, where the disease is spread primarily to unvaccinated
individuals — either infants too young to
receive the MMR (measles-mumps-rubella) vaccine or those who have
chosen, or whose parents have chosen, to avoid the vaccine.
Measles is
a serious respiratory disease caused by a highly contagious virus. It
spreads through the air when an infected individual coughs or
sneezes. The infection can also cause serious health complications, such
as pneumonia or encephalitis, and even death. Children younger than 5
years of age and adults older than 20 are at high risk of getting a
serious case of measles. About 1 in 4 unvaccinated people in the United
States who get measles will be hospitalized, and about 1 in 500 may die.
What should healthcare providers and the general public do about measles?
First
and foremost providers should ensure that all patients are up to date
on the MMR vaccine. Parents should make sure they and their children are
up to date on their vaccines. One in 12 children in the United States
is not receiving the first dose of MMR vaccine on time, leaving those
children susceptible to the disease if exposed.
Unvaccinated U.S.
residents traveling abroad are at risk for measles. Returning U.S.
residents and foreign visitors may develop measles and expose
unvaccinated and vaccinated people. The majority of importations of
measles into the United States come from U.S. residents.
Have you treated children with parents who have worries about vaccines? What are their concerns?
Yes,
parents come to me with concerns regarding vaccines. Some of
the concerns from parents include the pain of the shots, the number of
vaccines given to children under age 2, vaccines causing fevers, and
concerns that vaccines may cause autism, or contain mercury.
These concerns can lead parents to decline or delay vaccines for their children.
How do you respond to their concerns?
I
do a couple of things: First, I listen. The only way practitioners can
successfully address a question is by listening and really
understanding where it’s coming from.
So when a patient says, “I
don’t want the vaccines,” I listen and ask questions: “Tell me, what are
your concerns? What have you heard? Do you know of somebody who had an
adverse reaction to vaccines?” Maybe they saw something on TV, read
something on the Internet, or maybe they have a family member with
autism.
Listening is the first step; the next is to not preach or
indoctrinate. I give information, and I’ll be very frank with parents. I
say, “This is my area of expertise; let me tell you about this
vaccine.” I talk about what the vaccines are, what is in the vaccine,
what is not in the vaccine, because there are a lot of misconceptions.
Some people still think there is mercury in vaccines, but it is only
present in the multi-dose flu shot. I also make sure that I talk about
the diseases in question because oftentimes parents will say no to the
MMR vaccine, but I feel that it is my job as a physician to inform them
that there is an outbreak and to talk about what nobody wants to talk
about — that children can die from this. And then I ask if they have any
questions. I give them literature and time to decide. My goal is to
help parents make an informed decision.
What can happen when some parents decide not to vaccinate their children against diseases such as measles or whooping cough?
If
enough children do not get immunized, it can break down community
immunity and pose a danger to kids who are either too young to get
vaccinated or unable to get vaccinated (e.g., children being treated for
cancer), as well as those children for whom the vaccine did not provide
immunity (unfortunately, vaccines are not 100% effective).
Immunization
of adults, pregnant women, and adolescents is also very important. Moms
and dads who get vaccine-preventable diseases can pass them on to their
babies and children, who may not be old enough to have gotten all of
their vaccines yet. Some diseases, like whooping cough, measles, and
flu, can be deadly for babies. Children can get these diseases from the
adults who care for them.
Parents, grandparents, older siblings,
and anyone who cares for babies should get their flu
and Tdap (tetanus-diptheria-pertussis) vaccines. Parents may need other
vaccines as well and should ask their doctor which vaccines are
recommended for them.
Some parents who are wary of vaccines believe that “herd immunity” will protect their child. Is that the case?
Some
vaccine-refusing parents believe that vaccine-preventable diseases are
not a threat. Herd immunity means enough people in a community are
immune to a contagious disease — either through vaccination or prior
illness — to make its spread from person to person unlikely. Even people
who have not been vaccinated are offered some protection because the
disease has little opportunity to spread within the community.
But
when measles gets into communities of unvaccinated people (such as
people who refuse vaccines for religious, philosophical, or personal
reasons), outbreaks are more likely to occur. These communities make it
difficult to control the spread of the disease and make us all
vulnerable to having the virus re-establish itself in our country
again.
What are the real risks of vaccination?
Vaccines
are safe. For more than 30 years, the United States has had a vaccine
safety system in place to ensure that vaccines are as safe as
possible. There is no evidence to support a link between the U.S.
childhood immunization schedule and autoimmune diseases, asthma,
hypersensitivity, seizures, child developmental disorders, learning or
developmental disorders, or attention deficit disorders.
The main
risks associated with getting vaccines are side effects, which are
almost always mild (redness and swelling at the injection site) and go
away within a few days. Serious side effects following vaccination, such
as severe allergic reaction, are very rare, and doctors and clinic
staff are trained to deal with them. The disease-prevention benefits of
getting vaccines are much greater than the possible side effects for
almost all children.