The Vaccination Gap There’s Danger In Not Immunizing Children On Time, Doctors Say

No child enjoys getting shots of any kind. But not getting them can pack a far sharper sting.

Since the advent of immunizations of infants and children, America has enjoyed a sharp decline in infant mortality — so much so that the instances of diseases such as measles and whooping cough have dropped by 95{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} or more. The medical community at large doesn’t dispute that immunizations have saved countless lives, and some diseases have become so rare that parents occasionally wonder if vaccines are still necessary.

And therein lies the rub for doctors who are concerned about a downward trend in childhood immunizations nationwide — the possibility that parents are becoming more lax.

Researchers for the U.S. Centers for Disease Control and Prevention, reporting in the November issue of Pediatrics, have reviewed national data on immunization rates and discovered that only 9{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of U.S. children receive all the vaccines they need at the right time by their second birthday.


“Vaccinations received too early may result in less than optimal protection,” Elizabeth T. Luman, who headed up the study, told Reuters Health. “When vaccinations are given late, children remain unprotected for a period of time. This can result in disease for the individual child, as well as the increased possibility of disease outbreaks in the country.”

The fact is, she noted, although instances of many diseases are indeed way down due to immunization, many still exist, although they occur rarely, and vaccinations still play a major role in keeping children healthy.

That’s why public health agencies and school systems nationwide, including in Massachusetts, have significantly in-creased their vaccination requirements over the past two decades. Getting parents to abide by those guidelines is another story.

Increasing the Dose

Vaccines are basically a way to prepare the body to fight illness. Each immunization shot contains either a dead or a weakened germ, or parts of one, that causes a particular disease. The body, in effect, ‘practices’ fighting the disease by making antibodies that recognize specific parts of that germ, leading to long-term immunity.
It’s easy to see why children are immunized against so many more diseases than they used to be, said Dr. Matthew Sadof, medical director of Pediatrics at the High Street Health Center in Springfield.

“More of them are available now,” he stated matter-of-factly. To doctors who have always touted the value of vaccinations, it does seem to be as simple as that.
For example, in the past 10 to 12 years alone, children routinely began receiving the hepatitis B vaccine, a new pneumococcal vaccine, and a chicken pox vaccine. “There are a lot more than there used to be,” Sadof said — certainly more than the measles-mumps-rubella battery that most children of Baby Boomers grew up with.
Even that classic MMR immunization has a 21st-century twist: children in Massachusetts are getting it twice. The reason has to do with the success of the shot more than anything else.

“There were outbreaks of mumps in college-age populations, and one of the things we learned was that, as the natural occurrence of MMR was decreasing, people weren’t getting boosted by re-exposures to the illness,” Sadof said. “Over time, immunity would wane, so we needed a booster shot for MMR.”

To attend public schools in Massa-chusetts, children are also required to receive a number of immunizations, often multiple shots, against polio, diphtheria, tetanus, and others.

“We do give a lot more vaccines than we used to, even in the 1980s,” Sadof said. “But all these diseases have serious consequences, and all of them can be prevented through vaccines.”

Public schools in the Commonwealth take their lead from the Mass. Depart-ment of Public Health, which relies on several national groups — including the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians — to craft its own guidelines.
Failure to Communicate

Still, even though a specific battery of vaccinations are generally required to attend public school, that doesn’t mean parents are keeping up with the recommended schedule early in their children’s lives.

In her report in Pediatrics, Luman revealed findings from a national immunization survey conducted in 2000 that includes information on when 16,211 children between the ages of 24 and 35 months received vaccines.

U.S. health officials currently suggest about 15 different vaccines for children before they reach 19 months of age. However, Luman and her team found that only 24{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the survey group had received the recommended vaccines to prevent hemophilus influenza type B (known as Hib), and only 27{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of them had been vaccinated against diphtheria, tetanus, and pertussis according to schedule.

Luman noted that, while children need a large number of vaccines early in life, it can be difficult for their parents to keep track of them all — particularly when the diseases in question are so rare that parents question the urgency doctors place upon immunizing against them.

Dr. Bruce Gellin, who spoke at the American Academy of Pediatrics’ national conference in Boston recently, said pediatricians need to face parental perceptions head-on in an effort to understand concerns that might lead parents to avoid having their children immunized altogether.

“The topic of childhood vaccinations is complex. There are issues about how many vaccines a child needs, when they are needed, how often they are administered, how much vaccines cost, and how they actually work,” said Gellin, executive director of the National Network for Immunization.

“It is impossible for a physician to know which of these is of greatest concern to parents without involving them in a dialogue that teases out an individual parent’s specific questions and concerns and provides appropriate, accurate responses.”

y is a typical concern among parents, he said. But groups such as Gellin’s and the Immunization Action Coalition stress that it is impossible to get a disease from a vaccine made with dead bacteria or viruses.

Meanwhile, the immunizations made from live, weakened viruses, such as chicken pox or the MMR group, could indeed result in a mild strain of a disease, but it is almost always less severe and more manageable than getting it from an infection.

And vigilance leads to increased safety, doctors say. For example, the polio vaccine used to be a live virus. But the success of that program made it possible to switch to a killed-virus form of the vaccine, eliminating the possibility of polio being caused by immunization.

On the other hand, lapsing immunization rates among preschoolers led to an epidemic of measles in the U.S. between 1989 and 1991, in some cases causing death or brain damage. Similar outbreaks of whooping cough were reported in Japan and the United Kingdom during the 1970s after rates of immunization declined.“People who become complacent don’t realize how dangerous some of these diseases are,” Sadof said.

There’s another good reason to keep up the vaccination regimen, he noted, one that suggests major benefits for adults.

Simply put, immunizations early in life will decrease the instance of sickness later on — and, as a result, decrease use of and dependence on antibiotics. That, in turn, slows down the inevitable resistance built up to antibiotics on a population-wide level.

Just the Facts

Immunizations aren’t 100{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} propositions, but they do typically work in 85{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 99{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of cases, doctors say, and that percentage tends to rise in proportion to the number of children being immunized in a certain population. Parents need to be made aware of facts like these, doctors say.

In the information age, however, when patients are educating themselves like never before, parents are often faced with an overload of information about immunizations from the Internet, newspapers, television, and other people, much of which may be conflicting, Gellin said.

“Although there’s lots of information available, most parents have few ways of sorting out which of it is valid,” he said. “That’s why we believe in-depth conversations with pediatricians and other trained medical personnel are essential … especially if confusion or concern would keep parents from having their children vaccinated.”
He noted a 1999 study by the National Network for Immunization Information that warned about the likelihood that once-dreaded diseases currently under control could return if vaccination levels drop too low. The message, he said, should be that a parent’s failure to vaccinate not only puts one child at risk; collectively, that inaction endangers everyone.

Dr. Gilbert Ross, medical director of the American Council of Science and Health, believes vaccines have done more to protect children from death and illness than any other type of health intervention.

“The benefits of childhood vaccination are more evident today than at any time in the past half-century,” he said. “And evidence shows that vaccines are likely to provide even greater benefits to public health and children’s health in the future.”

The government and the health community are doing their parts, doctors insist. The rest is up to parents.