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Vaccine phobia

Do vaccines save lives or do they cause problems to our children? An anti-vaccine parent movement is growing in our country. The Greek parent has to face the dilemma: should I regularly vaccinate my child, as recommended by my doctor and the Ministry of Health? Or should I refuse to vaccinate, based on the stories of mass media and information from the Internet, which communicate the disastrous effects of vaccines?

Over-exaggeration and scare-mongering that are frequently demonstrated by the mass media regarding medical issues like this don’t seem to help parents. The same is valid for the recent failures of the vaccine for the latest flu strain.

The reality is that no vaccine, like no medication, is 100% safe. For every medical intervention it is good to visualize a scale: on the one side, there are the benefits of vaccination. Vaccines protect from diseases that kill. Before smallpox was eradicated because of a vaccine, it had killed around 500 million people. 60 years ago, 20,000 babies were born every year in the USA with mental retardation due to rubella. Hundreds of scientific studies, and much work by researchers around the world, have given humanity solutions to fight dangerous microbes. On the other side of the scale, are the possible side effects from vaccines: usually immediate and transient, rarely long-term or permanent – existing but unusual. When both sides are weighed up, the scientific position leans towards the side of the advantages. The recommended vaccines save lives, they are working.

The new pandemic of vaccine phobia is supported by thinking parents, often belonging to upper socio-economic classes, with good intentions, who, out of love for their children, become vulnerable to misinformation. The “university” of the internet has played a catalytic role in direct access to a wealth of information on the issue, much of which, unfortunately, seems scientific, but is invalid. These half-truths and anecdotes outside the medical world, but with a medical shell, often don’t coincide with the current scientific data, and cause doubt to parents.

Parents who treat the vaccination of their children with skepticism are often those who have more ecological concerns, those who turn to alternative methods of medicine, the consumers of organic products, vegetarians, parents who refuse the use of antibiotics, and mothers who breastfeed. The latter, who, by breastfeeding their children, in fact apply the latest scientific revelations, choose also to deny them by not vaccinating their children. The refusal of documented medicine, the non application of the latest scientific guidelines and protocols, the rejection with the stroke of a pen of knowledge, that was acquired through the hard scientific work of many people around the world, constitute attitudes, which are very prevalent in our country and are due to many causes.

Does the exclusively breast-fed baby not “need” the vaccines? Scientific studies show that, indeed, babies who breastfeed exclusively are protected to some extent by some of the diseases against which vaccines act. But up to that extent only. Breastfeeding does not assume replacement of vaccines. Some breastfeeding babies may suffer lightly from pertussis, one of them, however, will end up gravely ill in hospital.

Very often, behind the hesitation to vaccinate, lies a very natural reaction of the parent: I don’t want my baby to be in pain. Unfortunately, most vaccines are still only injectable. Until there is more progress with potable vaccines, the pain of the intramuscular injection can be dealt with to a certain extent: breastfeeding during, or immediately after the vaccination, has proven to alleviate the child’s pain. Positive results have also been shown by anesthetic patches at the injection site, as well as by the administration of a sucrose solution to the baby at the time of the injection. The essence remains, that the pain of vaccines constitutes, on the one hand an unpleasant experience for child and parents, on the other hand something that doesn’t cause anything more than a few transient moments of stress.

Vaccination opponents also raise the following argument in their rhetoric: aren’t babies very “small” and “sensitive” to undergo so many vaccinations so early? The truth is that the baby’s defences are extremely low during the first year of its life. Pertussis in a one-month old baby constitutes a potentially fatal disease. Meningococcal meningitis strikes by causing meningitis in three-month old babies particularly. Pneumococcus sends previously healthy nine-month old babies to the hospital with severe pneumonia or septicemia. It is exactly the opposite of the argument that is valid: the smaller a baby is, the more fully it will be protected by the timely administration of certain vaccines.

Does the simultaneous administration of so many vaccines push the child’s immune system to its limits? Many researches around the world haven’t confirmed this theory. It is natural for the immune system of the infant to react, to fight hundreds of antigens and potentially dangerous microbes, to which it is exposed, daily and simultaneously. Other studies confirm that the co-administration of many antigens simultaneously offers the same safety and efficacy: real studies with real babies-volunteers divided into two groups, one that received the vaccines separately, and one that received them simultaneously, prove that there is no difference in their efficacy or safety.

Are we certain that there is no long-term negative impact by the use of vaccines? The answer is no, as the answer is also no for the long-term impacts of the use of infant formula, preservatives in foods, paracetamol, plastic toys or cell phones. However, they are still used. Science can never exclude all the possible impacts from every medical or human intervention. However, research with reassuring results is taking place in this field too: An American study, which was published in the medical journal Pediatrics in September 2001, didn’t find any connection between the levels of thimerosal intake by the administered vaccines and the appearance of autism. Another study, which was published a month earlier, found that the children, who got the basic vaccination against pertussis in time, didn’t present increased frequency of seizures throughout childhood. Three months earlier, a large study was published in the same journal, which concluded that timely vaccination, according to the recommendations during infancy, doesn’t increase the risk of appearance of any of the 42 neuropsychiatric diseases that were studied ten years later. There was no statistically significant difference favouring the children who were less vaccinated. Undoubtedly, more similar papers that will answer parents’ questions are urgently needed. We demand specific, certain answers where are children are concerned. However, it is surprising that many of the parents, who are concerned about the long-term impacts of vaccinations to their children, don’t have the same reservations about giving them formula or tea daily, products that may include, for example, multiple quantities of aluminum compared to vaccines.

“But these diseases are now rare and my child is not in danger if it doesn’t get the vaccine”. Here the issue takes another dimension. Science says that measles is now rare because most children get vaccinated against it. Before the era of the said vaccines, these diseases were very prevalent. In areas of Africa and the developing world, where modern vaccines don’t exist, pertussis, measles, tetanus, and diphtheria continue to kill thousands, millions of children every year. And history shows that, when the vaccination coverage of a population decreases, the disease very soon increases in frequency and epidemics appear. Some years ago, in Great Britain, parents didn’t vaccinate their children against measles, resulting in the appearance of an epidemic of the disease.

Because the danger of death from these diseases is today minimal and non visible, parents are focusing on the far smaller risks from vaccines themselves and choose to abstain from them. This is the difficulty of preventive medicine: we try to do everything possible when our child gets sick, but we have more difficulty doing what it takes so that it doesn’t get sick. The law requires that our little ones wear seat belts when they are in a car, irrespectively if some people sometimes don’t comply with it.

Here is where the essence of the dispute on vaccination lies: Is the protection of a population from dangerous diseases a matter of public health or individual, personal choice? Scientists describe the said herd immunity thus: when a large part of the population has immunity against a disease, having been vaccinated, it is more difficult for this disease to begin a chain of infections and an epidemic. However, if fewer people get vaccinated (less than 85% of the total), the whole community is at risk of the development of an epidemic. You cannot minimize your personal risk of getting sick if your neighbors and classmates are not vaccinated simultaneously. In other words, if five out of a hundred parents avoid vaccination, the five families will be protected by avoiding the risks of the vaccine, thanks to the other 95 who got vaccinated and put their children through the – minimum – risks of the vaccine. However, if twenty out of a hundred parents decide to avoid vaccination, then the other eighty, who have taken the risk of the vaccine for their children remain, at the same time, unprotected: an epidemic can affect him at any time, despite vaccination. The particularity of vaccines is that they work better if everyone gets them, and this is why parents bear a portion of social responsibility for their choices on the specific issue.

Of course the responsibilities of health professionals, who deal with mothers and their children, are much more important The scientific community should reassure parents that it doesn’t just “love vaccines”, that it doesn’t adopt, without criticism and evidence from research, every vaccine that comes to us from the West. Often, the economic embrace of doctors by the powerful pharmaceutical industry leads parents to reasonable suspicion. There are paediatricians in our country who recommend different vaccination schedules from the ones that are recommended by the National Committee. There are also famous doctors abroad who write books recommending postponements or cancellations of vaccines per case, all contrary to modern scientific documentation.

The main responsibility of the health professional is discussion with the parents and their informed consent. Today’s parents demand to participate in the decisions that concern the health of their child, to be given all the scientific information on the positive and any negative features of vaccines, and to be helped in order to overcome their fears and concerns. And that their actual informed decisions be respected.

Stelios Papaventsis MRCPCH DCH IBCLC 2010

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