The question on whether to immunize has been under debate for many years in our country. There seems to be two opposing sides both of which are backed up by scientific research. Parents can omit these vaccines by having doctors issue waivers to children whose immune systems may not tolerate them, or due to religious or philosophical reasons. Are vaccines safe and does the MMR really cause autism? Is it too easy for parents to sign waivers excusing vaccines when their children are really at risk?

A recent article in Time Magazine (June 2, 2008) focused on these questions and looked at both sides of this controversy.

The fact is, there are more vaccines now then ever before. American children receive 28 vaccines by their second birthday if they complete their schedule as recommended by the CDC (Center for Disease Control). And 77% of children are up to date in the U.S. by the time they start kindergarten. What’s making some health officials concerned is that there are more and more families now opting out of state vaccination requirements.

The issue the state departments and the CDC have is that we are starting to see more outbreaks of certain preventable diseases than ever before. Look, we know that people travel alot and these infectious disease bugs travel with them. So even if you don’t hear about any outbreaks where you live, there are diseases that are still endemic in other parts of the world ready to latch onto an unimmunized person and travel back to their hometown to start the next big public health threat. Besides the unimmunized, infants and the elderly are at greatest risk. One recent outbreak in 4 states originated with an unimmunized boy from San Diego who contracted the virus while traveling to Europe where measles was thriving among other unimmunized people in Switzerland.

Many people can be “healthy carriers” of diseases and be contagious but not have any symptoms such as diptheria, pertussis, meningococcus, mumps, polio to name a few.

There were over 65,000 cases of paralytic polio in the U.S. before the polio vaccine was available in the late 1950’s. This virus has been eradicated from the western hemisphere but continues to spread and cause disease in 4 countries: Nigeria, India, Pakistan and Afghanistan. I have many patients that travel to India and are at risk. So with all this international travel, people fromm all over the world are moving into your neighborhoods and their children are in the same classrooms as your children. In other words, many countries are importing diseases back to the U.S. and if you are unimmunized, you are at risk.

Those not immunized may feel that they are covered by the “herd-immunity effect” which would make it less likely that a pathogen would infect a susceptible person or group due to the high rate of immunization in the population. But this effect is not as strong as immunization rates drop.

I don’t want to ignore the fact that side effects from innoculations exist. Symptoms can be as mild as local skin reactions to high fever, seizures, or even serious or life-threatening in rare cases. The parents on the opposing side of vaccines question whether the safety of these vaccines have really been tested. This is a complicated question depending on how you define “safety” although thimerosal (mercury) has been removed from the majority of vaccines.

The question on whether autism rates increased due to this preservative in vaccines was dispelled as the rate of autism continues to climb as thimerosal has been removed since 2001.

The bottom line: there are risks if you vaccinate and risks if you don’t. The question we need to ask ourselves is whether the decision to immunize should continue to be an individual one or whether we need to be more socially responsible and only waive those children in which immunization would cause a greater risk. Who would that include? More testing needs to be done for sure as we try to give parents more reassurance and prevent future outbreak of disease.

Reference: Gold, R. “Your Child’s Best Shot, A Parent’s Guide to Vaccination”. Canadian Paediatric Society, 2006.

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