Don’t Sell Routine Immunizations Short

 

Louis Pasteur showed the way for vaccines to be one of the salient medical accomplishments of the 20th century.  An outstanding example: 10 % of mortality due to war wounds in U.S. troops in World War I were due to tetanus (lock jaw).  In World War II there were only 12 fatalities from tetanus in U. S. armed forces and 7 of them did not receive all the shots they were supposed to get.  Very few medical advances result in such nearly complete success.

The cause of whooping cough (Bordatella pertussis) was discovered in 1906.  Within 20 years the development of a vaccine and its wide use had reduced whooping cough incidence by 90% when only 81% of the children had received the vaccine (the unvaccinated children received the benefit of herd immunity—fewer cases to be exposed to).  In 1960 Ström in Sweden and in 1974 Kulenkampff in U.K. published papers about neurological complications of the vaccine.  In Sweden an elite committee reviewed the evidence and corrected Ström’s incidence of neurological complications from 1 in 6000 to 1 in 50,000.  Kalenkampff’s group was more cautious pointing out that they did not know the incidence of such complications in their target population without vaccination and that 1/3 of their 36 cases had had some pre-existing neurological problems.  Nevertheless, the media ran with the anti-vaccination agenda, so whooping cough vaccination virtually ceased in those two countries, and whooping cough yearly incidence increased from 50 to 100 cases per 100,000 population to 3000 cases per 100,000.  Japan, Russia and Australia had similar increases at slightly different times.  The United States is only beginning to see increases in whooping cough.  Notably, in Texas, the incidence doubled in 2002.  Portugal, Hungary, East Germany, Norway, and Poland have been spared the increases because they were unaffected by the anti-vaccination movement. In 1925 to 1930, just before whooping cough immunization became available, whooping cough deaths in Wisconsin varied from 73 to 158 annually.  By contrast there has been only one death from whooping cough in Wisconsin in the last five years.

The recipients of vaccines are mostly healthy, so vaccines must be extremely safe.  Smallpox vaccination was probably the least safe vaccine, but with the 30% mortality of the disease, the risks were considered acceptable.  Vaccinia, the live virus used for smallpox vaccination, had a mortality of 1 per million.  The best approach to smallpox introduction by terrorists is to have stockpiles of vaccine available for immediate use in the geographical area involved.  This approach has been adopted by the United States. Other vaccines have been blamed for various conditions:  autism, attention deficit disorder, sudden infant death syndrome, even though extensive detailed investigations have not confirmed these associations. If we permit undocumented and discredited evidence to reduce greatly the use of routine childhood vaccinations our fate will be a large number of adults susceptible to childhood diseases with much more serious consequences than when children had the natural diseases early in life. Measles and chickenpox are much more serious diseases in adults than in children. Chickenpox in adults has a mortality rate of about 3%.

Rubella is a special case because it is a mild disease at all ages, except in early pregnancy where it consistently causes severe birth defects in the fetus, the details depending on the exact stage of development when the infection occurred. Rubella vaccination in pregnant women can cause birth defects just like a natural infection. As a live attenuated virus, a vaccinated child could cause birth defects in her unborn sibling by passing the vaccine strain to her mother, a very strong reason for attaining high vaccination rates for the measles, mumps, rubella combined vaccine, known as MMR.  At present the vast majority of women in America are immune to rubella long before they reach childbearing age, a very desirable situation.  A generation ago intrauterine rubella was one of the common causes of birth defects and we must not forget how the problem was solved (or it won’t stay solved).

Here are some very beneficial opportunities for new vaccines just around the corner.  The vast majority of cases of cancer of the cervix in women depend on infection with human papilloma virus.  A vaccine is in phase 3 trials.  If the trials are successful, whatever  it costs will be a bargain. A new use for chickenpox vaccine is likely to be promoted soon, a booster shot of chickenpox vaccine in late middle age may prevent shingles in old age. Patients made aware of this possibility have requested the booster shot because of personal contact with a debilitating case of shingles. Other vaccines at various stages of development include Helicobacter pylori for stomach ulcers and cancer of the stomach, a vaccine for cold sores, a therapeutic vaccine for malignant melanoma, a vaccine to prevent type I (juvenile onset) diabetes, and a vaccine for rheumatoid arthritis.  The FDA (Food and Drug Administration) has been aggressively tightening manufacturing standards for vaccines.  This should help us resist the blandishments of the anti-vaccination advocates.   Monroe was spared a big controversy about water fluoridation just before we moved here in the 1950’s.  The City Council approved the fluoridation and announced the date, but the equipment didn’t arrive on time.  Those who were predisposed to complain about side effects wasted most of their thunder.  Presumably this result was dumb luck.

 

John A. Frantz,

January 2, 2004