Recent publicity about adverse side effects from vaccines has made some parents confused about whether their children would be better off without the usual immunizations. Many wonder whether the risks of vaccines might outweigh their benefits. Recent medical research reinforces the view that for all of the standard childhood vaccines _ diphtheria, pertussis (whooping cough), tetanus, measles, mumps, rubella (German measles) and polio _ the benefits of immunization substantially exceed the risks. It is well known that all medical procedures have some degree of risk and immunizations are no exception.
On rare occasions their administration to an infant can be temporarily associated with side effects, most of which are not serious. One must not forget, however, that the diseases they protect against also are dangerous. Whereas few children have a reaction, there is no doubt about the diseases' tendency to kill or to permanently disable a child. Medical science has taken tremendous strides in eradicating diseases such as measles, mumps and rubella. In fact, few experts consider them to be serious diseases anymore. The major reason for this has not been advances in treatment, but rather prevention.
Lately public concern has focused on the rare side effects of the vaccine against whooping cough, the "P" component of DPT vaccine. Its potential hazards were dramatized in a sensational three-part television documentary and in a book discussed on television and the radio talk show circuit.
This media attention was unfortunately quite biased. Extensive coverage was devoted to descriptions of children reportedly injured by the vaccine; ignored was the much more common (yet less attention grabbing) story of healthy children being immunized and living life to the fullest without the ghost of pertussis haunting their youth. Today's parents and even grandparents have not seen firsthand what a killer this disease was because they were born after pertussis was nearly eliminated in the United States.
This lack of knowledge about whooping cough has helped to lull many people into a false sense of security. Few things are more horrible for a parent than to see their children succumb to pertussis, choking and desperately gasping for air, vomiting and becoming dehydrated, eventually having parts of their lungs and brain destroyed from hemorrhaging, lack of oxygen or both.
The medical profession has become alarmed by the potential morbidity and mortality that would be associated with a return of the disease. Dr. Paul F. Wehrle of the American Academy of Pediatrics (AAP) notes that "Pertussis, the disease, would potentially produce 10 times the rate of brain damage as the pertussis vaccine."
Recent medical research indicates that it may not be the vaccine itself but rather when it is given that is a key factor to adverse reactions. Infants six months or younger seem most susceptible to vaccine reactions. Severe neurological disease sometimes manifests itself in infants during the same age period that the vaccine is administered. Perhaps many of the vaccine "reactions" really are not caused by the vaccine but would have happened anyway and are more "guilt by association."
Some have argued that today's healthier lifestyles and advanced medical treatment have created an environment in which we do not need to immunize our children against these diseases. Solid data proves that this argument is false.
A few years ago, England and Japan eliminated the pertussis protection from the DPT immunization because the disease's incidence was decreasing. Sadly, the result was a severe pertussis epidemic in both countries. In England, there were more than 100,000 cases and 36 deaths, and in Japan 13,000 cases and 41 deaths. Parents in these nations learned the hard way that pertussis still is a threat and that epidemics will occur, even in the most advanced and industrialized countries.
In addition to pertussis, a large number of other potentially fatal diseases are waiting in the wings. Even the long-forgotten malady of diphtheria still occurs in the United States occasionally because of unvaccinated children. Additionally, the outbreak of measles in the late 1980s should further drive home the point that we simply cannot become complacent about vaccinating our children.
Treatment remains much less definitive or successful for any of these preventable childhood diseases. The best option remains in prevention.
Another publicized story, perhaps better characterized as a rumor, falsely linked the pertussis vaccine to the sudden infant death syndrome (SIDS). Again, this opinion is unsupported by solid medical data.
A major nationwide research study administered by the National Institute of Child Health and Human Development and completed in 1982 showed no evidence of a link between SIDS and DPT vaccine.
The study analyzed more than 800 SIDS cases from all over the country. The SIDS study actually found that vaccinated children were less likely to have SIDS as opposed to the unvaccinated children. This led the AAP to issue this statement: "Although the entire medical community hopes the cause of SIDS is soon detected, there is still no answer to this tragedy. What we do know, however, is that the pertussis vaccine _ as well as any other childhood immunization _ is not the cause."
Parents have a right and duty to be concerned about the unfortunate and unlikely possibility of brain damage from the pertussis vaccination. The bottom line is that the danger of serious side effects from the pertussis vaccine, if they exist at all, are much less than the known risks associated with the disease itself.
Although difficult, given media sensationalism, parents should not be swayed from protecting their children.
Perhaps the best advice comes from Dr. Benjamin Spock, who writes in his book Baby and Child Care, that whooping cough "is a disease to avoid like the plague if you have a baby in the household."
Parents who do not have their children immunized are denying them the miracle that has practically eradicated many serious, untreatable diseases. Vaccination is the strongest and most secure lock that we now possess fastened on a Pandora's box of killers of our children. For their sake, let's keep that reliable lock firmly in place.
Bruce A. Epstein, M.D., has practiced pediatrics in St. Petersburg since 1973. He lives in Seminole.