Understanding Vaccines – Booster Shots

With the whooping cough outbreak in 2012 and the flu epidemic that swept the country this past winter, vaccines again took the national spotlight. Still, questions and controversies remain about how this fundamental health precaution affects us all.

The young parents certainly have their hands full.

Aaron O’Brien grapples with his restless 2-year-old son, Dillon, while Robin Hubenschmidt hoists the couple’s daughter, 3-month-old Riley, in a carrier. They all traipse dutifully down the halls of the Oakland County walk-in clinic in Pontiac on a recent evening to fulfill what they believe is a basic parental duty: to have their children vaccinated.

“Riley has had all of her 2-month-old vaccines. I want to make sure what she is due for at 3-months-old. Dillon is due for his third DTaP,” Hubenschmidt says, referring to the diphtheria, tetanus, acellular pertussis vaccine.

Here at the clinic, nurses will check the Michigan Childhood Immunization Registry to find out exactly what immunizations Dillon and Riley need. That can take time — but it is more than worth it, say Hubenschmidt and O’Brien, both 24, of White Lake.

“I believe in getting the children vaccines,” Hubenschmidt says. “There are too many things that can happen.”

Oddly enough, she adds, “some people are against vaccines. I’m surprised when I hear that. I usually ask why.”

This scene sums up in many ways the world of immunizations in 21st century America. Few routines are as common as getting shots at the clinic, doctor’s office, or even, these days, at the local drug store in order to avoid contracting any number of diseases like the flu, or shingles. This young family is a typical sight at the Oakland County clinic.

But as common as vaccines are — and as long as they’ve been around — they have remained confusing and controversial. In addition, some may believe a particular disease is no longer a threat, and then stop vaccinating for it. The spread of inaccurate information via the Internet can be a major fuel for this and other false information.

As a result, some may refuse or delay vaccinations, putting themselves or others at risk. Such behavior, unstemmed, could help “stage the comeback” of diseases nearly unknown today, according to materials published by the Centers for Disease Control and Prevention in the U.S. Department of Health and Human Services. “Before long, we would see epidemics of diseases that are nearly under control today. More children would get sick and more would die,” the CDC says.

This is unfortunate and it is 100 percent unnecessary, experts agree. Vaccinations are life-saving and crucial “from birth through the span of life,” says Kathleen Forzley, manager and health officer in Oakland County’s Health Division. But what should be a no-brainer for people who live in a world teeming with diseases that once killed millions has become complicated.

This is largely due to hysteria and misinformation, which feeds on the normal human inclination to be careful, especially with the health of a child.

The much-hyped, so-called vaccine-autism link was completely discredited, but not before millions of parents declined to vaccinate their children at all — or according to recommended schedules — which is key to vaccine effectiveness. Other controversies regarding influenza vaccines are equally exaggerated, if not fabricated. Many believe vaccines have serious side effects — also not true.

The official response to these stubborn concerns? Relax. Vaccines are safe.

“Most of these are largely the same vaccines people have been receiving for decades,” says Shane Bies, administrator of Oakland County Public Health Nursing Services. “We still are asked about autism and also the preservative, thimerosal,” once used in vaccines. “These have long since been removed from vaccines.” In addition, no link between this substance and autism ever existed; it was predicated on faulty data, and then went — no pun intended — viral.

What Bies calls “delayed or alternate schedules” also remain obstacles to immunization compliance. This refers to parents who either put off vaccinating their children at recommended times, or space out vaccinations that should be administered at the same time.

“The concern is that their children’s immune systems are getting overloaded with too many vaccines, especially compared to the number children received many years ago,” Bies says. “But today’s vaccines are much more efficient in triggering immune responses.”

Another reason for misunderstanding vaccines is the confusing nature of having to keep up with a lifetime of immunization protocol.

In fact, immunizations are not just recommended for babies, but also for adolescents, adults, and senior citizens. Lack of knowledge or old biases can cause some people to delay or even forgo these immunizations.

For example, says Oakland’s Forzley, some who recall the first influenza vaccines of the 1970s, which caused some serious problems initially, may not be comfortable getting today’s flu vaccines, even though these vaccines are safe and effective. “People say, ‘I don’t need a shot. I’m healthy, I never get the flu.’ But you never know when you might get suddenly run down,” she says. Adults over 65 are most susceptible to flu and should always get their annual flu shot.

Next year, Bies says, the flu vaccine will cover four strains of flu for the first time. It has covered three for many years in the past, so this is a considerable advance.

Equally important is that vaccinations can avoid the spread of disease. Symptoms often come after diseases are contracted, so you can spread disease to others unknowingly. One tragic example of the consequences of forgoing vaccinations due to ignorance or bias is the recent pertussis, or whooping cough outbreak, the worst in 50 years. There were more than 41,000 cases nationally in 2012; 17 infants died of this totally preventable disease.

Too many people think this longtime disease has been eradicated, or that once vaccinated as a child, you are immune for life. But pertussis is still with us, and adults can pass it onto their babies or grandchildren inadvertently.

Why? Because 90 percent of adults have not gotten adult booster shots, one of many adult immunizations recommended. Thus, the recent outbreak.

“There is very low awareness among adults that they need vaccines, too,” says Kristine Sheedy, associate director for communication science at the CDC’s National Center for Immunization and Respiratory Diseases in Atlanta. “Vaccines are recommended for adults to prevent diseases such as influenza, shingles, pneumonia, and whooping cough. Some vaccines can even prevent cancer, such as the hepatitis B vaccine, which can prevent hepatitis B and liver cancer that can develop after developing chronic hepatitis B.

The hard lesson learned here? “You’re not making the decision to vaccinate just for yourself,” Forzley says. “You’re making the decision to protect those you work with, live with, and care about.”

Meanwhile, adolescent vaccination rates could be much better, too. The high point is an 80-percent compliance rate for DTaP for 13- to 15-year olds. But the human papillomavirus (HPV) vaccination, which prevents cervical cancer in girls, is still at just 50 percent compliance, and is not increasing.

All of this is why Forzley and Bies help lead a vigorous education outreach among the public, physicians, and health agencies — with good results.

They have increased the county’s immunization rate by 19 percent, to 70 percent for the 19-36 month age range, and administered 66,417 immunizations at their two clinics; the other is in Southfield. They provide reminder notes to parents and assistance to health agencies.

These efforts mirror those by other counties, the State of Michigan, and the CDC, which is on the front lines of the immunization compliance battle.

The good news? The old controversies are dying and educational efforts are working. “Fortunately, the vast majority of parents are vaccinating their children according to the recommended schedule,” Sheedy says.

With the hard work of people like Forzley, Bies, Sheedy, and physicians and health care workers; and with the obedient diligence of parents like O’Brien and Hubenschmidt and adults and senior citizens, the diseases vaccinations prevent may one day go the way of smallpox.

That horrible disease, a scourge from ancient times until 1980, has been eradicated. Experts say polio is also close to disappearing.


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