Vaccines and Immunizations – Dr. David Long

Vaccines and Immunizations

• Dr. David Long discusses vaccines and provides arguments both for and against their use

• Reasons people may object to vaccines include: religious beliefs, government recommendations, possible harmful side effects

• However, the risks of not being vaccinated are usually much greater than the risks of taking a vaccine

• For example, while there is a small risk of Sudden Infant Death Syndrome (SIDS) from the DTaP vaccine, this is dwarfed by the number of cases prevented

 • Vaccines help protect not just individuals but also entire communities through herd immunity

Full Text

Vaccines. Just saying it may invoke some emotion in some people. There’s certainly reasonable arguments for them. There’s reasonable arguments occasionally not to use vaccines. I’m Dr. David Long. I’d like to take a few minutes today to try to separate some fact and fiction regarding vaccinations. 

There are some reasonable reasons to object, to the use of vaccines. Maybe someone doesn’t want to use vaccinations of any kind because of a religious belief. Maybe a person like me, who doesn’t like the government telling them what to do will reject the idea of using a vaccine just because the government recommended it. Or perhaps it’s because you think that it’s harmful to your children, may be harmful to you as an adult. If we’re going to talk about vaccinations, the first thing we have to understand is the concept of relative risk.

I can’t even tell you that wearing a seatbelt is safe. I can tell you that wearing a seatbelt is safe relative to not wearing a seatbelt. There are about a dozen people who die every year because they wear their seatbelt. They fractured their clavicle in it. It severed their subclavian artery. They had an injuries to their jugular vein. They couldn’t get out of their car and they drowned, or other versions of death in a car wreck. But the point being, even if that happened to someone very close to me, would it be reasonable for me to tell other people, “Don’t wear your seatbelt anymore, They’ll kill you.” Well, no, that’s ridiculous because the relative risk is nowhere close. That’s commonly what we have with vaccinations. I would not argue that there’s no side effects from vaccines ever. I would only argue that the relative risk is nowhere close with a benefit versus the risk of vaccinations. 

First off, what is a vaccine? A vaccination is when we take pieces of a bacteria or pieces of a virus, or maybe an inactivated weakened form of the virus, and we give it to the patient in such a way that it stimulates your immune system to think you’re sick, to think you just got diptheria or pertussis or measles or polio or the flu. And it responds to it. The thing is our immune systems are so geniusly engineered. You make antibodies that you keep so that you would be prepared if you actually did get exposed to the real bacteria, to the real virus, your immune system would respond and you wouldn’t even get sick from it. 

Now, if we’re talking about the flu, certainly you’re going to miss school. There’s 40,000 deaths a year from the flu that are preventable. But other things like measles and diptheria and pertussis, those are much more deadly when patients get those kinds of things. And they’ve been almost completely eradicated because of effective vaccinations.

 A common concern is, okay, so maybe it’s just a little piece of a protein called an antigen, or maybe it’s just a weakened virus, but what else is in that shot? Well, just, just take a bird’s eye view here. What interest does a pharmaceutical company or a physician have in injecting, unsafe things into our child, when the whole point is to keep them from getting sick? There seems to be a contrast of interests there, but the things that are in a vaccine, like maybe there’s formaldehyde, oh my goodness. Well, formaldehyde is common in many things that we eat and drink in very, very, very small harmless doses. Same as the vaccine. There’s arsenic in some vaccines. There’s arsenic every time you eat an apple, but we wouldn’t slap the apple out of your hand because you’re making unhealthy choices because of arsenic. So we have to keep these things in perspective and ask ourselves, “What’s the risk of not doing it, versus the risk of taking a vaccine, versus not taking the vaccine?” 

There’s four common arguments against using vaccines. And I thought I’d break those down one by one and see if we can get a little bit more truth on this subject to help us make better decisions. One of the most common arguments against using vaccines is that the diseases had already started to disappear. For instance, the person who wants to attack the polio vaccine will show the last of many polio outbreaks, and note that cases were coming down and we developed the vaccination towards the end of a polio outbreak. And while that’s true, as we look back through the historical record at 20 years before that the polio outbreak and 30 years before that polio outbreak, we have to admit that since that vaccine came in there haven’t been any more. So while that disease may have been going down during that outbreak, it would likely have come back if we didn’t have an effective vaccination.

There is a direct correlation between a precipitous drop of a disease rates when we have a useful and a relatively safe vaccination. Measles in 1963, we saw a precipitous drop to where we have very few cases now in the United States, except in hotbeds of places where there’s a large percentage of people who either can’t get vaccinated or choose not to. We see them crop up there, but otherwise rates are very low. 

Haemophilus influenza. A good vaccine came out in 1990, well after we had good sanitation. So we can’t say that the drop off was because of sanitation. And there was a precipitous drop in the cases of Haemophilus influenza. It went from 20,000 a year in 1990, only 1.4 thousand in 1993. We can even see the effect in this when we go in reverse. Great Britain, Japan, Sweden – in the seventies, there was a concern about the safety around the diptheria of vaccine. And so they stopped vaccinating. And in Japan, between 1974, where they had no cases to 1978, they had a hundred thousand cases of diptheria attributed to them stopping their vaccination program for fear of some side effects of the diptheria vaccine.

The second reason that people often give for not using vaccinations is because they cause harmful side effects. One common association was the diptheria, tetanus and pertussis vaccine, and its correlation with SIDS, sudden infant death syndrome. But the reason that that came about was because children who have the sudden infant death syndrome commonly have that most often around the age where they would get about three of the DTAP (diptheria, tetanus, and pertussis) the DTAP vaccines. So it seemed to be correlated, but that’s not really any different than me saying that eating bread causes car wrecks. Well, maybe, but what of eating bread, caused that car wreck? There may be a correlation, but it doesn’t establish any causation. And in fact, multiple high quality studies during the 1980s demonstrated that the number of SIDS (sudden infant death syndrome) was exactly what you would expect it to be from chance, having no causation relationship with the DTAP vaccine whatsoever. 

Number three, my kid doesn’t need to have them because that disease has been almost eliminated. Well, our current Measel situation in the United States really challenges that notion. But I think there’s a couple of important things to consider there. A) we use vaccines to protect ourselves. The diseases are still here and unvaccinated people are still susceptible and B) we use it to protect our community.

There are people in my community who cannot get a vaccine, or even if they did their immune systems will not respond. I protect that person by their community being vaccinated, herd immunity, which you may have heard of. This is not that different than me abiding by the traffic laws, rather than me driving as fast as I want to because everybody else will take care of me and look out for me because they’re abiding the laws. That’s not how community works. 

Number four, this one is common. Many of us have seen the picture of the little doll that has all of the injections poked into the doll, showing all the vaccines that kids get. And it looks horrible, but that’s one of the things I love about science. Science doesn’t care how I feel. It just presents, the data and lets you make up your mind about it. Of course, seeing a doll with all these shots stuck into it seems terrible. But what we know that we know that we know, is that the small amount of antigen, that is the small stimulation of a child’s immune system from a vaccine, is not nearly as much as all of the antigens one gets when they eat food. The bacteria that’s introduced into your system exposes your immune system to many antigens. When you get strep throat, you’re exposed to somewhere between 20 and 30 antigens, little proteins that stimulate your immune system. So when we use a vaccine that we’re isolating just a very few antigens in order to trigger a response from your immune system and make you create antibodies so that you’re immune. So we don’t see, any bad outcomes from the schedule of multiple vaccines for a child over a short course of time. The problem is when we assume there must be something dangerous about that. And we don’t vaccinate that child. We spread out the vaccination schedule. Then we’re making that child more susceptible to preventable illness during their most vulnerable time of their life in their infancy.

A vaccine that we have available and commonly used at the Lubbock Cooper health center is vaccinations for meningitis; for that college aged student who needs to get their meningitis vaccine. I have heard and read some concerns about that particular vaccine in relation to something called Guillain-Barre syndrome. Guillain-Barre syndrome has to do with when our immune systems react in an abnormal way to something and make antibodies that attack our own nervous system. And the thinking is; the concern is; the ill informed position is that, we gave them this vaccine and their immune systems responded to that vaccine in such a way that they made antibodies that attack their immune system and caused this terribly debilitating Guillain-Barre, and the truth is that can happen, but it is much, much, much more likely for your immune system to react to strep throat and cause a Guillain-Barre or a stomach virus and cause aGuillain-Barre. Nothing about the vaccine makes it any more likely that you’re going to have that, than all of the other myriad of infections that are our immune systems are exposed to every day. So while I couldn’t tell you, it’s never happened, I can tell you that meningitis happens commonly Guillain-Barre syndrome from a meningitis vaccine: exceedingly exceptionally rare. 

So at the Lubbock Cooper health center, we typically have vaccines for the 10 to 12 age kids on up through high school and college. I would recommend that if you have questions about childhood immunization, that you contact your pediatrician, they’re experts on that topic. I hope you found some of this useful. If you have any questions, give us a call, or click on the link below for more information.

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