There is no decision more personal than whether or not to immunize one's children. Information regarding the safety and effectiveness of today's vaccines is readily available but is overshadowed by opinion and hyperbole offered up by celebrities and others. In light of significant recent outbreaks of vaccine-preventable diseases all over North America, it's a good idea to explore the issues.
NursesAnnouncementsArchiveArticle
To immunize or not to immunize... that is the question. When I was growing up, there really wasn't any controversy - when we were in certain grades, we were all lined up at school and the public health nurse either gave us a shot in the arm or a little pink drop of sugary liquid on a plastic spoon. I have a nice, circular scar on each of my upper arms just below my shoulders that signify my immunization against smallpox, the only disease to have been declared eradicated from the Earth. When my children were small they each were given their shots according to the vaccination schedule of the time. It's what we did. Then came Andrew Wakefield.
The study published by Mr Wakefield purported to link immunizations with the development of autism and it set the world on its ear. The fact that this study has been debunked scientifically a number of times seems not to penetrate the consciousness of a growing group of parents who feel that herd immunity will protect their children. The principle of herd immunity is simple: if enough of a herd of any species is immune to a microbe the odds of an outbreak of that microbial disease are extremely low. And should an outbreak occur, it rapidly diminishes as the number of susceptible hosts drops. Well, guess what... the herd isn't immune any more.
Outbreaks of vaccine-preventable diseases like measles, mumps, rubella, pertussis and varicella have been documented all over complacent North America. Combined with a falling immunization rate, high-speed intercontinental travel allows these diseases to gain a toehold and then they are free to run rampant through populations with low or NO herd immunity. Communicability begins before the infected host becomes symptomatic, so spread is difficult to contain once it begins. Measles had been declared eliminated in the Americas in 2002, with small sporadic outbreaks annually; there were 85 cases on the continent in 2005 and as many as 253 in 2010. But in 2011, the WHO American region reported the highest number of cases seen since the disease was reported eliminated. My city has just recorded its second measles case in as many weeks after years of zero cases and we've had two infants with congenital rubella admitted to our PICU in recent months.
"So what's the big deal?" people say. Health care has changed since the 50s and 60s, and kids don't die of vaccine-preventable diseases any more. Right? Wrong. Children and adults DO die of these diseases, although the number is small and complication rates remain manageable. For now, at least. Even so, people still believe that it's all hype and not really anything to worry about. They forget about the children and adults who are unable to be immunized, not for lack of wanting it but because of other health issues. Children with cancer, blood dyscrasias, organ transplants and certain neurological disorders cannot be immunized against certain diseases. Adults who have been inadequately immunized as children for whatever reason are also at risk. And it's this population who are at risk for dying from chicken pox. Or measles. Or to become sterile from the mumps. Or to have a baby with severe anomalies from congenital rubella. It's not a joke.
In the course of researching my family tree I have come across entire families wiped out by pertussis and measles, and others by typhus, cholera, or scarlet fever (infections that while not vaccine preventable, have been essentially eradicated by modern-day antibiotics and sanitation practices). I'm always deeply saddened when I find them, and I fear that if the current complacency and disdain for immunization continue we may find ourselves right back there.
As pediatric nurses we have a unique opportunity to help make this better. We have many teachable moments in the course of our workday where we could reinforce the message that not only are vaccinations safe and effective, but also that parents aren't only protecting their own children, they're protecting those they encounter out in the world who aren't lucky enough to be able to protect themselves. We can remind them that no one knows what the future might bring and that someday they may find themselves with a child who can't be immunized. I remember a family that had 5 children. None of them were immunized because the mom was opposed. Their fourth child became critically ill and needed a heart transplant. The discussions with this mother were intense and, on some level vaguely threatening when it was pointed out that the child would surely die if one of the siblings brought home a vaccine-preventable disease after going through a transplant. She asked for some time to research things and in the end agreed to have all of her children immunized.
My challenge to you is to examine your own thoughts and feelings about vaccinations from a scientific rather than an emotional perspective. Then I challenge you to formulate your responses to parents who are on the fence about having their children immunized so you have them ready when the opportunity arises. Our future is counting on you.
