To vaccinate or not to vaccinate: When your child’s health and life is at question.

Reyna Hernandez

Fall, 2005

Thesis

Child immunizations/vaccinations have greatly decreased the child mortality rate in the United States , yet some parents still decide not to immunize their children. Even though there can be some risk associated with vaccinations, overall, the benefits outweigh the risks

Outline

I. Introduction to vaccinations

i. What vaccinations are and what they do

ii. History

1. Background

2. Statistics of child morbidity rates

iii. Types of vaccinations

iv. Why we need vaccines

1. Herd immunity

2. Nation-state regulation and mandates

i. Brief history of the antivaccination movement

ii. Religious objection

1. The basis of religious objection to immunization

2. Religious and moral objections to certain vaccines

iii. Fear

1. Vaccination risks

2. Controversy between the correlation of vaccines and autism

iv. Brief overview of the CDC’s guide to contraindications to vaccinations

III. Conclusion

i. Summary of points

ii. Thesis

 

Introduction to vaccines

It is hard to imagine in today’s society that anyone would not know what a vaccine is, even if they don't know what a vaccine is about. Although they do not play an obvious role in our everyday lives, unless we want to travel to another country or if we are the parents of small children. It is hard to forget the ‘feeling’ vaccinations leave with us. Vaccines and immunizations are normally considered to be the same thing, but according to Stern and Markel (2005), the latter is a more inclusive term because it implies that the “administration of an immunologic agent actually results in the development of adequate immunity”. Yet they both serve the same purpose, to vaccinate or immunize against some disease. Webster’s New World Dictionary & Thesaurus define vaccines as: 1 a substance containing the cowpox virus used in vaccination against smallpox 2 any preparation so used to produce immunity to a specific disease; immunize to make immune, as by inoculation. Once again, Stern and Markel (2005) clarify a vaccine as a “suspension of live (usually attenuated) or inactivated microorganisms (e.g. bacteria or viruses) or fractions thereof administered to induce immunity and prevent infectious disease or its sequelae.” One must note that, even though a person who has been immunized can still get sick, the illness will not be as severe of an effect on that person.

Background

It is interesting that Webster’s dictionary references the cowpox virus in regard to smallpox, a disease that was last reported in the 1970’s, because it ties into some of the history behind vaccines. The first vaccine made to combat a deadly illness was the smallpox vaccine, discovered by Edward Jenner. According to Wikipedia (2005),

In 1796, during the heyday of the smallpox virus in Europe, an English country doctor,Edward Jenner, observed that milkmaids would sometimes become infected with cowpox through their interactions with dairy cows' udders. Cowpox is a mild relative of the deadly smallpox virus. Building on the foundational practice of inoculation, Jenner took infectious fluid from the hand of milkmaid Sarah Nelmes. He inserted this fluid, by scratching or injection, into the arm of a healthy local eight year old boy, James Phipps. Phipps then showed symptoms of cowpox infection. Forty-eight days later, after Phipps had fully recovered from cowpox, Jenner injected smallpox-infected matter into Phipps, but Phipps did not later show signs of smallpox infection.

It is from this successful procedure that immunization took off. This new form of preventative care has decreased child mortality rates of certain childhood diseases by almost 100%; see Table 1 (Malone and Hinman, 2004).

Table 1: Comparison of Twentieth Century Annual Morbidity* and Current Morbidity of Vaccine-Preventable Diseases of Children in the United States
DISEASE	TWENTIETH CENTURY ANNUAL MORBIDITY		2000†	PERCENTAGE DECREASE
Smallpox		48,164	0	100
Diphtheria	175,885		4	99.99
Measles	503,282		81	99.98
Mumps	152,209		323	99.80
Pertussis	147,271		6755	95.40
Polio (paralytic)	16,316		0	100
Rubella	47,745		152	99.70
Congenital rubella syndrome	823		7	99.10
Tetanus	1314		26	98.00
Haemophilus influenzae type b and unknown (<5 years)	20,000		167	99.10
*Typical average during the 3 years before vaccine licensure.
†Provisional data.

How vaccines work

Once a vaccine is injected, the body’s immune system recognizes the inculded agents of the vaccine as foreign and attacks the agent. During the immune response certain white blood cells, known as memory B cells, ‘remember’ the agent. Since the body’s immune system can then remember the foreign antigen, the next time it comes into contact with it, the immune system can respond by (1) neutralizing the target agent before it can enter cells, and (2) by recognizing and destroying infected cells before that agent can multiply to vast numbers (Wikipedia, 2005). Today we have many different types of vaccines to cover different kinds of disease (see Table 2).

TABLE 2: TYPES OF VACCINES (Wikipedia, 2005)

	VACCINE TYPE	Uses
Traditional	Inactivated	Developed from previously virulent microbes that have been killed through heat or use of chemicals. Most of these vaccines have incomplete or short-lived immune response and often require follow up booster shots. Examples : against flu, cholera, plague, and hepatitis A.
	Live, attenuated	Developed from live micro-organisms that have been cultivated so that their virulent properties are disabled. Typically these vaccines provoke a more durable immune response. Examples : yellow fever, measles, rubella, and mumps.
	Toxoids	Developed from inactivated toxic compounds derived from microbes in which their toxins, not the organism itself, cause illness. Examples : tetanus and diphtheria
In Development	Conjugate	Developed from bacteria with polysaccharide coats. These polysaccharide coats are linked to proteins, such as toxins, so that the immune system can be led to recognize the polysaccharide coat as if it were a protein antigen.
	Subunit	Developed by introducing only a fragment of a micro-organism to an immune system, which then can develop an immune response to the micro-organism.
	Recombinant Vector	Developed by combining the physiology of one micro-organism and the DNA of another. Immunity can therefore develop against diseases that have complex infection processes.
	DNA	Developed from an infectious agent’s DNA. This DNA undergoes insertion and expression (which in turn triggers immune system recognition) in human or animal cells.

Why do we need vaccines?

If vaccines have been so effective at eliminating once deadly childhood diseases, why do we need to continue to innoculate our children?

In order for a vaccine to be effiecient, a large percentage of the community must be vaccinated to stop or slow down a disease. According to Wikipedia (2004), as long as the vast majority of people are vaccinated it is much more difficult for an outbreak of disease to occur and spread. The population gains what is refered to as herd immunity. The people who are vaccinated, in a sense, protect those who are not because the spread of illness has diminised. Yet if a person who has been immunizied comes into contact with an infectious disease, they could still spread it to those who have no immunity. Furthermore there are still possibly fatal diseases that one can incurr that are not ‘spreadable’ diseases like tetanus. The CDC recommends that at least 95% of the population should be vaccinated in order for herd immunity to be effective.

In order to protect society, government and state officials have regulated and mandated vaccines. School and daycare regulation plays a huge role in the prevention of spreadable disease. Of course this may cause some unrest with citizens because they feel that by making immunization mandatory, it infrenges on their civil liberties. Moreover, the state has the constitutional authority to enforce police power. The ‘police power’ is the authority reserved to the states by the Constitution and embraces “such reasonable regulations established directly by legislative enactment as will protect the public health and the public safety” (Malone and Hinman, 2005). A main target of such regulation is the public and private school system as well as some daycare regualtion. School and daycare regulation play a huge role in the prevention of spread of infectious disease.

One Supreme Court case in 1944, Prince v. Massachusetts, involved the asserted rights of religious freedom and child labor laws, ruled that:


Neither rights of religion nor rights of parenthood are beyond limitation. Acting to guard the general interest in youth’s well being, the state as parens patriae may restrict the parent’s control by requiring school attendance, regulating or prohibiting the child’s labor, and in many other ways. Its authority is not nullified merely because the parent grounds his claim to control the child’s course of conduct on religion or conscience. Thus, he cannot claim freedom from compulsory vaccination for the child more than for himself on religious grounds. The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death. (321 U.S. at 166–7, 64 S.Ct. at 442) [Malone and Hinman, 2005]

Even though there are such regulations set forth to protect society, there are some cases where exemption from vaccination apply. The most common exemption is religious exemption.

The Controversy and formation of individual beliefs regarding vaccines

A brief history of the antivaccination movement

Stern and Markel (2005), The History of Vaccines and Immunization: Familiar Patterns, New Challenges, stated that an antivaccine sentiment first began in the 1830s. According to Stern and Markel, many antivaccinationist considered vaccines to be an intrusion of their privacy and bodily integrity; new vaccination laws were seen as a direct government assault on their communities by the ruling class. In addition, by the mid-eighteenth century irregular medicine and quackery helped fuel the antivaccination movement (Stern and Markel, 2002). Such discourse led nation-states to articulate that they had they right to immunize for the “common good.”

Religious Objection

As noted before, there are some exemptions in which a person can opt out of being vaccinated. One of these exemptions is the religious exemption. This states that any person/parent can qualify for such an exemption if their religious beliefs entails that, by not giving the vaccines, is what they must do to follow God’s will for them in fulfilling their roles as responsible parents. That their child’s immune system is a creation of God and that God has given their child and that to vaccinate would violate their faith in what God has created (Mercola, 2005). Staver (2001) goes on to say that "These individuals believe that God created the human body as a temple and that the body should not be destroyed by injecting a virus into the body."

Another aspect of the religious objection to vaccination has to do with the origin of certain vaccines. There are some vaccines that have been developed from and as a result of aborted human fetuses, see Table 3 (Staver, 2001). The use of aborted fetus cells to develop vaccines tends to be conflict with most religious beliefs.

Table 3 U.S. Vaccines Derived From Abortion
Disease, Vaccine Name/ Cell line Fetal, Manufacturer

Polio	Poliovax, MRC-5	Aventis-Pasteur
Measles, Mumps, Rubella	MMRII and Biavax, WI-38	Merck & Company
Rubella only	Meruvax II
Rabies	Imovax, MRC-5	Aventis-Pasteur
Hepatitis-A	Havrix,, MRC-5	SmithKline-Beecham
	Vaqta, MRC-5	Merck & Company
Chicken pox	Varivax, WI-38 and MRC-5	Merck & Company

A final reason as to why some people may choose not to vaccinate their children is due to fear. There is fear that children are becoming 'pediatric pincushions' (Colgrove & Bayer, 2005). Also, according to Colgrove and Bayer (2005) "The spread of dissenting views of vaccination has been facilatated by the Internet, where dozens of websites challange the safety and efficacy of vaccination."Although there are great benefits to vaccination, there also is some risk involved. Severe reactions can occur in children due to vaccines. The child can become very ill, develop a painful scarring skin reaction, or could possibly die if the reaction is severe enough. Some of these reactions can be seen on the Center for Disease website regarding vaccine reactions at http://www.bt.cdc.gov/agent/smallpox/vaccineimages.asp.

There has also been much speculation over the correlation between vaccines and neurological damage. The tendency to try to find any correlation between devastating childhood illness and death has not died out even in today’s society. It seems that for some people, vaccinations are the key culprit for such unexplained happenings. One of the big controversies today involves whether or not the vaccines containing the preservative Thimerosal, which is derived from mercury, is responsible for autism. Before the 1990s, 1 in 10,000 children were diagnosed with autism. But in the past decade, as the government has increased the number of mandatory vaccines, some recent studies suggest the rate of autism has risen to1 in about 250 children (Williams, 2002). As of yet, it has not been proven that there is a direct correlation between the use of Thimerosal and autism (Stein, 2005)..

The CDC’s Guide to Contradictions

Today it is becoming more common place for healthcare providers to give parents pamphlets informing them of what the vaccine administered is and what to look for in case of a severe reaction. The center for disease control has a comprehensive article as to what to look for and when a child should not be vaccinated; it can be accessed on http://www.cdc.gov/nip/recs/contraindications.htm.

 

Conclusion  

Child immunizations/vaccinations have greatly increased the child morbidity rate in the United States , yet some parents still decide not to immunize their children. Even though there can be some risk associated with vaccinations; overall, the benefits outweigh the risks. People may choose not to immunize their children based on religious grounds or because they feel it is an infringement upon their bodies. Although once common diseases are no longer noted, they still pose a great risk to the health of our society as a whole. Thus, it is deemed necessary to mandate that persons belonging to a society get immunized for the common good.

Bibliography

• Agnes, M. (Ed). (1996). Webster's New World Dictionary and Thesaurus. New York, NY: Macmillan.
• Center for Disease Control. The Guide to Contraindications to Vaccinations http://www.cdc.gov/nip/recs/contraindications.htm Accessed on September, 2005.
• Center for Disease Control. Vaccine Reaction Images. http://www.bt.cdc.gov/agent/smallpox/vaccineimages.asp Accessed on Oct., 2005.
• Colgrove, J. Bayer, R. Could it Happen Here? Vaccine Risk Controversies and the Specter of Derailment. Health Affairs. Vol.24. Accessed through Academic Search Premier on September, 2005.
• Malone KM, Hinman AR. Vaccination Mandates: The Public Health Imperative and Individual Rights. In: Goodman RA, Rothstein MA, Hoffman RE, et al., eds. Law in Public Health Practice. New York: Oxford University Press, 2003: 262-84. http://www.cdc.gov/nip/policies/vacc_mandates_chptr13.htm Accessed on September, 2005
• Mercola, Dr. Joseph. Nearly All Children Can Qualify for the Religious Vaccine Exemption . http://www.mercola.com/2000/dec/10/vaccine_exemption.htm Accessed on September, 2005
• Staver, Mathew D. http://www.vaccinationnews.com/DailyNews/September2001/CompulsaryVxThreatenRelFree.htm Accessed on September, 2005
• Stein, Rob. Childhood Vaccines Pose No Extra Risk for Diseases, Study Finds. http://www.washingtonpost.com Accessed on September, 2005.
• Stern and Markel. The History Of Vaccines And Immunization: Familiar Patterns, New Challenges.Health Affairs. Vol. 24. Accessed through Palni Site search on October, 2005.
• Williams, Valeri. Mercury in childhood vaccines: what did the government know?http://www.tetrahedron.org/articles/vaccine_awareness/children_mercury.html Accessed on September, 2005
• Wikipedia. Herd Immunity. http://en.wikipedia.org/wiki/Herd_immunity Last modified on Oct. 2004. Accessed September, 2005.
• Wikipedia. Vaccine. http://en.wikipedia.org/wiki/vaccine Last modified on Aug. 2005. Accessed on September, 2005.

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