[Couple of the usual propaganda phrases: Vaccination is one of the greatest public health accomplishments of the 20th century, and Dr. Wooten counters that the viruses causing many diseases are still at large­a short plane ride away.]

Immunization: Parents Weigh the Odds

by Cynthia Jenson-Elliott

This winter, a measles outbreak in San Diego County highlighted the issue of childhood immunization. In January, 11 children at the San Diego Cooperative Charter School (SDCCS), a school with a large number of unvaccinated children, came down with the measles. It was the largest measles outbreak since 1991, when 1000 people contracted measles and three died.

While Centers for Disease Control (CDC) statistics show that approximately 95 percent of American children are vaccinated before they reach first grade, some parents still do not vaccinate their children. Perhaps they may not know about vaccination, may not believe it is important, or may not have access to healthcare. For other families with access to information, healthcare and insurance, choosing not to vaccinate is a philosophical decision. After careful research, deliberation, and discussions with their doctors, they have come to believe that, on a personal level, the risks of immunization outweigh the benefits.

Sybil Carlson is one such parent. Using research skills honed by a master’s degree, Carlson has looked thoroughly at the issue and weighed the odds. She believes that immunization puts her children at a greater risk than that of not immunizing at all.

“I looked at what the CDC said and talked to our doctor,” Carlson says. “Then I started to read journal articles and found some of the actual studies [which] conflicted with what the medical community was saying about how often side effects happen, the effectiveness of vaccination, and the types of side effects.”

Dr. Robert Sears, an Orange County pediatrician and author of The Vaccine Book: Making the Right Decision for Your Child, often hears concerns about vaccines and potential side effects from the parents of his patients in his pediatric practice.

“They worry about the lack of long-term safety research,” Sears wrote in an email interview. “The initial groups of tens of thousands of infants that take part in the side effect studies for each new vaccine are only studied for one to two months post-vaccination. No one has followed these groups of children to see what problems might show up months or years later.”

These issues factored into Carlson’s decision. “Some studies [for vaccine approval] were not very long or thorough,” she contends. Despite known complications from vaccines ranging from ear infections to death, “the acceptable risk for vaccination is greater than the acceptable risk for other medications,” Carlson says, “the theory being that vaccination is for the greater good [and that] you’re saving more than you’re harming.”

San Diego County Public Health Officer Wilma Wooten, MD, MPH, worked closely with SDCCS to contain the measles outbreak. She is a strong advocate for preserving the greater good through vaccination.

“Vaccination is one of the greatest public health accomplishments of the 20th century,” Dr. Wooten says. “In [developed countries in] the west, the prevalence of disease is low because we do vaccinate.”

Some parents who choose not to vaccinate believe that many diseases dangerous in the developing world are not a problem for children in the U.S.

“Parents don’t tend to fear diseases that have been virtually eradicated from our country,” Dr. Sears writes. Parents who breastfeed their children or do not put their children in daycare may also feel less threatened by disease, Dr. Sears believes, and may view the vaccines themselves as a greater risk.

Dr. Wooten counters that the viruses causing many diseases are still at large­a short plane ride away. “In any given year, we have one or two isolated cases [of measles],” Dr. Wooten says. “If you’re exposed [and not vaccinated] you’ll get the disease.” And these diseases, as mild as they sometimes are, can still be dangerous. “It’s not just those people who would die that is the issue,” Wooten says. “There are other complications.” Those complications range from ear infections to pneumonia, encephalitis, and seizures.

Public health officials worry about large scale outbreaks when unvaccinated children spread diseases to those who cannot yet be vaccinated, such as children under one year of age, unborn fetuses and those for whom vaccinations have not provided complete immunity.

No vaccine provides 100 percent immunity, Dr. Wooten points out. But research studies of vaccination effectiveness have led to an understanding of just how well they work. “One vaccination might establish 95 percent immunity to an illness, while two vaccinations give a person 99 percent immunity,” Wooten says. These “booster” shots have increased the numbers of vaccinations children receive to 39 over 12 years as compared to the 15 vaccines given 20 years ago.

Sears says that this increase is one of the chief concerns of parents in his pediatric practice. “They worry that the increased exposure to extra chemical ingredients in today’s vaccine schedule hasn’t been adequately researched,” Sears writes. These ingredients can include aluminum and mercury.

Sears believes in offering parents alternative and selective vaccination schedules to address these concerns. The selective vaccination schedule includes “only the most important vaccines to protect against diseases that are potentially fatal and somewhat common in our country,” such as pertussis, meningitis and Rotavirus.

Sears cautions that parents who choose this “selective” vaccination schedule may be viewed as “selfish” for “only considering their own individual baby’s health and declining to take part in the overall public health and disease prevention for the less serious diseases.”

Another alternative vaccine schedule is available which includes all vaccines, but gives them at a more gradual and age-appropriate pace. Public health is still safe, Sears says, because children are protected “from every disease by the time it becomes a risk.”

Preserving public health and individual wellness are Wooten’s main concerns, and she believes immunizations are the way to achieve both. Her goal is to have 90 percent of San Diego’s children immunized by 2010.

“I understand parents’ concerns with the number of vaccines,” Wooten says. “It’s not pleasant to give young children shots. But it’s a small price to pay to prevent long term disability and illness, not only for the person infected, but for the parents who have to care for the child who is ill.”

For his part, Sears believes that parents must intelligently weigh the risks and complications of disease versus the risks associated with immunizations when making choices. In the meantime, as parents continue to exercise their individual rights, public health may be hanging in the balance.

Cynthia Jenson-Elliott is a freelance writer, parent and teacher, and the author of four books of non-fiction. She lives in San Diego and may be contacted at cjensonelliott@san.rr.com .