Calling the Shots

by Lori Solomon

Every parent in the pediatrician’s waiting room knows what the wails coming from down the hall mean. Shots.

Children in this country receive an estimated 200 million vaccine doses annually, according to the Centers for Disease Control and Prevention (CDC). The recommended immunization schedule for children has grown both in number and complexity in recent years. Meanwhile, health experts reassure parents that the added vaccinations are safe and essential to children’s wellbeing.

“We do have more immunizations than we used to, and from my perspective that is a great thing. Now we can prevent diseases that we used to not be able to prevent,” says Dr. Melinda Wharton, deputy director of the CDC’s National Center for Immunization and Respiratory Disease.

Infants and young children, who are most vulnerable to contagious and potentially deadly diseases such as diphtheria and pertussis (whooping cough), receive vaccinations early. In the first 15 months of life, children may receive up to 25 shots, including five new vaccines that have been introduced to the children’s immunization schedule since 1995: varicella (chickenpox); rotavirus (diarrheal disease); hepatitis A; pneumococcal (pneumonia); and influenza (flu).

Doctors recommend that 11- and 12-year-olds get vaccinations to prevent meningococcal diseases, the flu and human papillomavirus, or HPV, which can cause genital warts, cervical and anal cancers. 

Do Vaccines Pose a Risk?

Vaccinations do not overwhelm a child’s immune system, the American Academy of Pediatrics maintains, and, in fact, the germs contained in the shots pale in comparison to those that children are exposed to daily while playing, eating, even breathing. The number of antigens that children fight every day is estimated to be 2,000 to 6,000 – far greater than the number in any combination of vaccines on the current vaccine schedule (or 150 for the whole schedule combined).

While the national recommendations for when and how many vaccines should be administered are the standard of care in pediatricians’ practices, there is some flexibility built into the schedule and some pediatricians are willing to spread out vaccinations within a given age range. “The vaccinations must be received on time to achieve maximum protection possible,” Wharton says. “Some families choose to administer the vaccines within the range but not as many at one time. But, there is a limit to how many [office] visits most people want to make.”

But to address concerns over vaccine safety, the National Vaccine Injury Compensation Program was established in 1988. Since then, there have been only about 14,000 petitions filed claiming that the shots caused harm. Of those, 2,700 claims have been paid for injuries ranging from anaphylactic shock to permanent upper arm damage to polio infection caused by a vaccine.

Vaccine safety rose to the forefront of medical journals and popular news reports following the initial publication of a now-discredited study in 1998 that claimed an association between the MMR vaccine and autism. The study by British researcher Andrew Wakefield, now exposed as an “elaborate fraud” by the British Medical Journal, did ongoing damage to public health. It is now known that Wakefield misrepresented or altered the medical histories of the 12 patients who were included in his study. Additionally, Wakefield, whose medical license was revoked, failed to disclose that he had been paid more than $670,000 by a law firm that intended to sue vaccine manufacturers. 

Risk from Vaccination Refusal

While the risk of any vaccine causing serious harm is extremely small, health experts say the risk from not vaccinating is very real.

High vaccination rates are necessary to stop diseases from spreading or penetrating a community. The more people who are vaccinated, the more that helps protect those who may not be vaccinated, or whose immune systems are compromised (such as cancer and organ transplant patients), or those whose vaccinations did not fully work. CDC data shows that diphtheria, tetanus, poliomyelitis and rubella have been virtually eliminated in the United States. Hepatitis A and B have declined 89 and 81 percent, respectively, compared to pre-vaccine era estimates.

Despite some parents’ concerns about shots, the country’s vaccination rates remain high. In fact, in September, the CDC reported that immunization rates for 19-35 month old children for most vaccine-preventable diseases are increasing or remaining at high levels, with rates for the most commonly recommended at or above 90 percent. But according to research from Georgia’s Immunization Program, the state’s childhood immunization rates peaked in 2004 at 81 percent and have dropped to 78 percent in 2008, the most recent year that data are available. (Within the metro Atlanta area, immunization rates varied from 93 percent in Gwinnett County to 69 percent in Clayton. Fulton’s rate was below 75 percent.)

“We have found through our work that people who refuse vaccinations cluster geographically,” says Dr. Saad Omer, an infectious disease epidemiologist at Emory’s School of Public Health. “If the refusals were spread out evenly, the risk might be lower.”

“Your community’s refusal rates affect your child’s risk. Vaccines are very good, but they are not 100 efficacious,” Omer says. So, he says, even if you do the “right thing” and get your child vaccinated, it may not be completely effective in preventing disease. If your child is surrounded by unvaccinated people who are more susceptible to disease outbreaks, “their risk goes up depending on who is in their playgroup or whom they go to school with.”

Pertussis, mumps and measles outbreaks continue to occur throughout the country. In 2010, nearly 9,500 cases of pertussis were reported in California alone, the most in 65 years. In 2012, 118 cases of measles had been reported in the country in the first four months of the year, the highest number since 1996, with many occurring in California and Minnesota. Almost 90 percent of the cases involved people who had not been vaccinated and who had contracted the disease while traveling abroad (both U.S. residents returning from travel and international visitors). Forty percent of the patients had to be hospitalized.

Georgia has been spared outbreaks like those seen in California and Minnesota – so far. “There are pockets of measles in communities not fully immunized, and it could become more widespread if larger percentages of people are not vaccinated,” says Dr. Robert Wiskind, an Atlanta pediatrician.