Vaccine Refusal: Turning Back Two Centuries of Progress

Vaccines have become a victim of their own success.  In 1809 Massachusetts became the first state to pass a law requiring a vaccination – of smallpox – ushering a series of public health victories over a number of serious diseases.  In the past 200 years smallpox has been eradicated, and measles, polio, rubella and tetanus have become so rare that they have disappeared from public consciousness.

The number of children who contract vaccine-preventable diseases today is tiny compared to the number before the era of vaccines.  Before measles vaccination there were 500,000 reported cases of measles annually in the US.  In the last few years the average has been 62 per year.

Perhaps because of this spectacular success, parents are now much less aware of the terrible consequences of vaccine-preventable diseases, and some parents are increasingly concerned about the risks of vaccines.  Despite the fact that the risks associated with vaccines are extremely small, unfounded rumors and beliefs about these risks continue to circulate.  In the last few years increasing numbers of parents are refusing vaccination for their children.

An important article in this week’s New England Journal of Medicine summarized the trends in vaccine refusal, the reasons parents cite for refusal, and the risks of vaccine refusal.  The article supports what we already thought we knew.  Obviously, unvaccinated children are more likely to contract vaccine-preventable diseases.  But more importantly, clusters of unvaccinated children put at risk other children around them.  For example, children who cannot be vaccinated because of medical problems depend on the general immunity in their surrounding community to keep them healthy.  Children whose parents refuse vaccination put those children who cannot be vaccinated at risk.

Southern California is known for its wonderful heterogeneity of ideas and lifestyles.  We think ourselves cool because we drink free range coffee and eat nothing but organic tofu and weave our sandals from post-consumer hemp.  But some ideas, besides being false, are also profoundly harmful.  While public health officials struggle with crafting policies to make vaccination more ubiquitous, you and I have to make it clear that refusing to vaccinate your kids is just not cool.

Tangential miscellany:

I received many positive responses (and some new readers) from last week’s post about the virus previously known as swine flu.  I hope the new readers aren’t bored when I get back to writing about diabetes and cancer screening.  Most health topics aren’t as funny as the potential worldwide spread of a new virus!

There is much less buzz (thank goodness) about H1N1 (swine) flu this week, but I thought a brief update would be useful.

  • Over 30,000 people die of the regular garden-variety flu in the US annually.
  • Swine flu by any other name is still not transmissible by eating pork.
  • As of today, the number of confirmed cases in the US is 1639, and the number of deaths is 2.  Both deaths were in patients with other chronic health problems.
  • The number of Tamiflu prescriptions I’ve written since this started is zero.
  • I still stand by everything I said last week.  To clarify, the reason you shouldn’t panic isn’t because you won’t get it.  We’ll all get it (or a vaccine) eventually.  The reason not to panic is that it won’t be that bad.
  • In my opinion the CDC and WHO have handled this epidemic wonderfully and the media have handled it terribly.
  • If in retrospect you believe that you were made more scared about this than you should have been, maybe it’s time to stop getting information from television.  Get your information on the web from reliable sources.  (See links below.)

Learn more:

New England Journal of Medicine article:  Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases

A year ago I wrote about a measles outbreak in unvaccinated kids:  U.S. Measles Cases at Highest Numbers Since 2001

My post last week on the virus previously known as swine flu:  Swine Flu: Unlikely to End the World

The Centers of Disease Control page on H1N1 (swine) flu

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