Editor’s note: The following answers about vaccinations were provided to the World by Dr. Christopher Smith, Chair of Pediatrics at the OU-TU School of Community Medicine and OU Physicians-Tulsa
Why are vaccinations important?
The short version is that vaccines (immunizations) prevent known illnesses and save lives. It is estimated that vaccination programs have prevented more than 100 million cases of contagious disease since 1924. Today, vaccines protect children and teens from 16 diseases including measles, chicken pox, Hepatitis B, Meningococcal meningitis and many more.
What are the side effects from vaccinations?
The most common reaction with vaccines are local reactions (swelling, redness and pain) where the shot was given and can last for up to seven days. Fever is a less common reaction that begins within the first 24 hours and lasts one to two days. For some of the vaccines (MMR and chickenpox) the reactions are usually delayed by one to four weeks. Severe allergic reactions can happen with any vaccine, but are very rare. There are also reactions to getting vaccines, like fainting, that are more related to the emotion of getting a shot than a reaction to the vaccine.
Is there a way to know beforehand, whether an individual is allergic to any particular vaccination?
There is really no way to know beforehand about a possible allergic reaction. There is a national immunization information system where providers of immunizations log details about immunizations that are given and any possible reaction to an immunization. The information collected is constantly monitored for potential issues and reactions and notifies providers across the country when there could be an issue.
The National Vaccine Injury Compensation Program pays for those deemed injured by vaccines. What vaccines are currently causing injuries?
The National Vaccine Injury Compensation Program was created in the 1980s as a no-fault alternative to the traditional legal system because the numerous lawsuits at the time threatened to cause vaccine shortages for all children. Any vaccine, as is the case with any medication, might possibly have side effects. The severe allergic reactions to vaccines covered by this program are for all commonly administered vaccines. The best website to find out more information is hrsa.gov/vaccine-compensation.
What rates do vaccines causes injuries?
Information from the National Vaccine Injury Compensation Program shows that from 2006 to 2017, more than 3.4 billion doses of covered vaccines were distributed, 6,253 petitions were reviewed by the court, and 4,291 were compensated. That puts the risk of severe injury at 1 in 1 million. A good source of information on the science behind vaccine safety can be found at American Academy of Pediatrics’ website, bit.ly/2w2i9np.
Discuss the links that have been made to vaccines and autism.
The potential association between vaccines and autism was raised in 1998 in a paper in The Lancet, a British Medical Journal. Since then, numerous scientific studies have shown no increased association between vaccines and autism. Also, the original paper published raising this question was later retracted due to ethical misconduct in the way the study was conducted. A good source on vaccine safety can be found at cdc.gov/vaccinesafety.
Explain what is meant by the phrase “herd immunity.”
Herd immunity is a term for the protection all children (the herd) get from living in a community where the majority of people are vaccinated. Therefore, unimmunized children have some protection when a majority of children around them are immunized. For a community to count on the benefits of herd immunity, the vast majority of their children must be vaccinated. Unfortunately, the rate of immunization among 2-year-old children in Oklahoma is as low as 60% in some populations (children below poverty) and only just over 70% in other populations (children above poverty) according to American’s Health Rankings, placing us at 43 out of 50 states.
The governor of Kentucky was recently quoted as saying he exposed all nine of his children to chicken pox rather than have them vaccinated. What would you say to parents considering emulating this practice?
This has become a popular practice by some well-meaning leaders. The idea is that many adults had chicken pox and most didn’t have any problems. Unfortunately, several of us have seen severe side effects, including death, in children who had chicken pox. Severe bacterial infections of the skin, inflammation of the brain, toxic shock syndrome and Reye’s syndrome are all serious complications of chicken pox that many pediatricians remember. Immunization against chicken pox has eliminated these often fatal complications that some people don’t seem to remember.
What is driving all the discussion on the issue of immunizations now?
Looking back in history, it is easy to forget the many diseases prevented by the use of vaccines. The smallpox vaccine was the first vaccine introduced around 1800, and now we have eliminated smallpox. Rabies is extremely rare now. Polio was common in the early 1900s and left many people crippled is not a public health issue now. In times where diseases have been prevented and are not seen, it is easy to focus on perceived problems with vaccines. The anti-vaccine movement has waxed and waned in popularity through those years, fueled by high-profile celebrity messages highlighting extremely rare reactions and information posed as science that really isn’t science (like in the case with the proposed vaccine link with autism) and the idea that these diseases aren’t all that bad (as in the case with chicken pox) without remembering the very real complications of these diseases, which were much more common than vaccine reactions. Once good science, which takes several years, has proven the theory wrong, these ideas have already been embraced as fact. In the current U.S. measles outbreak, we are again reminded what happens when immunization rates fall and preventable diseases are once again spreading through neighborhoods.
According to the Oklahoma Health Department and CDC, the percentage of Oklahoma kindergartners who filed a record exempting them from any type of vaccinations increased from 1.9% in 2016-17 to 2.2% in 2017-18. Is this a concern?
Any time a child is not vaccinated for any reason is a concern. As mentioned, seasoned physicians and medical providers remember the days of concern over disease and complications that no longer exists because of vaccines. Providers realize parents may be concerned with the safety of vaccines and therefore provide as much complete information on possible side effects, and educate families on the benefits. When we see preventable illnesses creep back into our society, it concerns us all.
The 2017-18 state immunization survey found that 91% of public school kindergartners and 84% of private school kindergartners were fully vaccinated. What are your thoughts on these rates?
The immunization goal across the country is 95% or greater. So Oklahoma still has some work to do. It is possible the actual kindergarten immunization rates for Oklahoma are not actually that high as participation in the survey is not mandatory and only represents 89% of public schools (where immunization rates are higher) and 52% of private schools (where immunization rates are lower). The survey does not capture children who are home-schooled. As mentioned earlier, the number of 2-year-olds fully immunized is around 70%.
According to the kindergarten survey, some individual Oklahoma schools had exemption rates as high as 24% and 20%. The 24% rate was at a school with 50 kindergartners. However, in the latter case, 116 of 371 kindergartners at one school had filed exemptions from vaccinations. What are your thoughts on these exemption rates?
Exemption rates this high in certain schools and communities is alarming. The short answer is, yes, these children are at greater risk to get one of the 16 diseases prevented by vaccines and these schools and communities are at a much higher risk for being the place where the next outbreak could happen.
Currently, the kindergarten vaccination survey is voluntary. Should this be made a requirement of schools, to report vaccination rates to state officials (the current response rate is 89% in public schools and 52% in private schools)?
In any survey that will be used to monitor how effective Oklahoma is in achieving better health for all our citizens, it is helpful to make sure the response rate is as high as possible and speaks for everyone. A higher response rate, however that is obtained, would increase the validity of the survey results.
Given the current vaccination rate of kindergartners, could Oklahoma suffer a widespread outbreak of measles or some other disease otherwise covered by childhood vaccinations?
The reason the national goal of 95% fully immunized is important is to prevent widespread outbreaks of preventable diseases. The further a state falls below that average, the more likely an outbreak is possible. Given Oklahoma is toward the bottom on immunization rates, the likelihood is higher. That is why the Oklahoma Chapter of the American Academy of Pediatrics has included increasing immunization rates as part of their 2019 Blueprint for Children.
What are the common (non-medical) reasons given by parents for questioning or refusing vaccinations for their children?
Generally, non-medical refusal of vaccines can be grouped into four categories: religious reasons, personal beliefs or philosophical reasons, safety concerns or a desire for more information.
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