Many years ago as a student of naturopathy I was firmly anti-vaccination. Since then, I have gone on to become a registered pharmacist, and with the continuing education my opinions have also continued to change.
As a naturopath, we had an entire subject dedicated to the evils of vaccines. I was convinced. No one was going to go near my children with a vaccine. Studying pharmacy, vaccines were only mentioned briefly. My opinion when I graduated from pharmacy had not changed. I was a pharmacist against vaccines.
However, I had learnt how to read the medical literature and continued to read widely on the topic. Somewhere in it all, my opinions changed due to what I'd learnt. I'll share with you some of the concerns I've had over the years, along with the answers as I know them today.
Vaccination is to inject a dead or modified microbe that causes a disease into a person's muscle. The idea is that the immune system will respond to the microbe in the same way that it would to the natural disease, resulting in immunity. The goal is to control, eliminate or eradicate the disease.
Advocates for vaccination point to the suffering, death, and disability that can be caused by the diseases. Most of us at some point have been routinely vaccinated against diseases that were once linked to high rates disability or death. Measles, diptheria, tetanus to name a few.
Many argue against vaccines. As the incidence of these diseases fall, many no longer see that the benefit outweighs the risk. The suggestion of vaccines containing foreign proteins, mercury, contaminants and potentially causing other diseases scares people.
What you can be certain of is that if you choose to get the vaccine, you definately get the vaccine. At some point in the future, you may or may not come into contact with the disease.
So is it worth getting a vaccinnation for a disease you may or may not come in contact with? This is something you need to weigh up, particularly as a travelling family. Take a look at your itinery and asses:
- How likely are you to come in contact with each of these diseases?
- Are the risks greater than back home? Are there certain areas you can avoid during your travels to minimise your exposure or is the disease too wide spread/unpredicatable?
- How serious is the disease?
- What medical treatment options are there back home and on the road? Is the treatment worse than the disease, can the disease even be treated or is it a minor illness that's fixed with bed rest and time?
- What other prevention options are there, if any? And how effective are they?
What causes an infection? How are they prevented?
Vaccines only protect us against an infectious disease -- this is one where a microbe (such as a virus or bacteria) is able to enter our bodies and make us sick. Vaccines have helped decrease the number of people getting sick from these infectious diseases. Improved living conditions, diet and hygeine have reduced the rate of diseases, too.
It is well known that most travel diseases these days come from eating contaminated food or drink. Mosquito bites are another leading cause of travel diseases.
A healthy body is the best defence against disease. A balanced diet with plenty of fruit and vegetables, enough to eat and drink, keeping your body the correct temperature, living in sanitary conditions, breast-feeding ... these are all so important for avoiding diseases. Being careful about what you eat, and taking precautions against mosquitos will help protect against these diseases.
But travellers, we often live in cramped living conditions on the road. Our diet can be good, but depending on where we are sometimes it might not be as good as we want due to availability, accessability, and cost.
Hygeine also isn't what it could be in all countries of the world -- including developed nations like Australia, where personally I have just experienced one of the worst mice plagues that anyone can remember.
Is a healthy body 100% of the time a realistic aim for family travellers?
The Arguments For?
"Since Edward Jenner discovered vaccinations, vaccines have been one of the leading causes of reduction of child mortality and improvement of human life worldwide. So, despite the vaccine scares, I'm a big believer in vaccination, not just for my child but for the benefit of other children in the herd.
If you're from a developed country and travelling to other developed countries, your risks travelling with unvaccinated children are probably no higher than they are in your home country, because childhood vaccination programmes have substantially eliminated the risk of the most serious diseases.
One vaccine I'd recommend all parents consider for much of Asia, Latin America and Africa is rabies: rabies is 100% fatal if contracted. If you've had the vaccine, post-exposure treatment is an injection. If you haven't, it's a month-long course of injections.
Having seen the impact of polio on polio victims in the developing world, that's another disease I'd really rather reduce the risk of my child contracting.
I'm especially wary about arguments regarding natural immunity. People don't have natural immunity to diseases like tetanus, which can and do kill. I know lots of parents can and do travel with unvaccinated children, but to me it's a risk I'd rather not take."
Theodora from Travels With A Nine Year Old
Most health organisations around the world recommended we routinely vaccinate our kids. You may have seen the vaccination schedule expected during childhood. In most developed countries, these include diseases like measles, mumps, rubella, polio, diptheria, tetanus and whooping cough.
But when we're talking about travel vaccinations, we're not just talking about standard vaccines. We're talking about throwing in a whole heap of extra vaccines. These may include rabies, yellow fever, typhoid, japanese encephalitis, and hepatitis.
These diseases are around, and the risk varies across the world. We're talking about disease that are actually an ongoing threat in many nations, there is no herd immunity in these countries. Vaccines are recommended to protect you against the disease that is common in that region.
We've all heard about herd immunity. But what exactly is meant by that?
We need about 90% of people vaccinated to try and control or eradicate these diseases. And vaccines don't appear to work for everyone. So, to protect all people (whether unvaccinated, vaccinated, or those who are vaccinated but don't respond) we need at least 90% of all people vaccinated to prevent the spread of disease.
I can have the vaccine, and not have it work? What?
Yes. They don't work for everyone.
Depending on the vaccine, the percentages vary, but on average they work for about 80-90% of people. So, without a high level of vaccination, the "herd immunity" won't exist. So, a child is vaccinated to protect not only that child, but the entire community. How do you feel about that? For some people, it is really important. Other people consider that the decision made for just that child is the only thing that matters.
Some vaccines you can have a blood test to find out if the vaccine has worked. This includes diseases such as hepatitis B and rubella. These tests can show if you have a sufficient level of antibodies to protect you against the disease. Some people do not respond well to vaccines, and others respond rapidly. There are differences in everyone. There is a theory that we are still more likely to be protected than if we hadn't had the vaccine at all, even without a measurable antibody response. That doesn't make sense to me, but the theory is out there.
Haven't you seen the old photos and heard the horror stories of what these diseases can do?
Yeah, we've all seen the turn-of-the-century polio wards. If you haven't, take the time to google for them. We've heard the stories about children left permanently deaf from measles, babies deformed from the having mother rubella, or the man infertile from having mumps. These diseases few and far between in a developed city today.
Why? Many reasons. Better hygiene, diet, and living standards, to name a few. But in the developing world and in remote areas of even developed countries, some of these diseases are still prevalent.
The Arguments Against?
I have seen how an 18 month old was normal one day, went to the doctors the next day, and had his needles and has never been the same since. That family now has a 9 year old who can only half function in our school system, and has to be helped in every area of his life. Is that fair, or right, or even a cause of the side affects? Who knows!
I have since discovered a different way of living. I no longer go to the doctors, and do not believe in medicine. We are mostly vegetarian, and eat a healthy diet without any harm to our children.
I have five boys, and our youngest only got a few of his needles before we realised the danger involved with the side affects. We have not looked back since we turned our back on the medical system, and we love the information that we have from our Wholefoods Farmacist Desk Reference that we purchased from Don Tolman - we heal our family and ourselves with herbs, food,water and fasting.
I could not agree with immunisation, and if I had my time over with my five boys, they all would have been born at home without any vaccinations! Too many cancers are now linked to the medicine that we are told we need to help with health issues. The very idea of putting a disease into my boys body with a needle is not something that I would agree to now days.
Lisa from New Life On The Road
The arguements against are very persuasive. There's a lot of support for them, both anecdotal and scientific. A lot of modern parents question the risks of even routine injections, so exposing their children to even more vaccinations is an understandably scary prospect, with many choosing to travel without vaccinations.
There are a lot of arguments against vaccination. I'm not saying these arguments are wrong or misguided, I'm just going to discuss each one of them now from a pharmacist's perspective. There are of course many sides to each arguement, this is just one.
I don't want all that stuff going straight into my (child's) blood.
Actually, vaccinations don't go straight into your blood. Most of them go into a large muscle. Muscles are chosen because medicines are released very slowly from the muscle into the rest of the body. Many of these vaccines are cleared from the body really quickly, so if you put them straight into the blood they wouldn't even work.
It would be dangerous to put the vaccinations into the blood. That is why it's not done.
The immunity from vaccination is not the same as natural immunity
Well, actually ... you've only got one immune system. It only has the one way to build those antibodies.
The antibodies are exactly the same whether you had chicken pox, rubella or any other disease from the vaccine or from a disease.
These vaccines wear-off over time. They'll be more vulnerable as adults to these diseases.
Yes, you need boosters for many of them. In fact, there are some vaccines that require an annual booster. Many are effective for five to ten years.
This is what I consider to be the strongest argument against vaccinations. How many people in their 20s and 30s have had all of their booster shots?
So many people in their 20s and 30s are getting pertusis (whooping cough) because they haven't had their boosters. Did you know that adults should have a booster shot not only for tetanus, but diptheria and pertussis as well? Have you had yours? Many of these diseases can affect adults worse than children, so lets hope if they get a vaccine as a child that they will get their booster shots as an adult.
I'll vaccinate homeopathically.
I'm not even going to discuss 'homeopathic vaccination' as, being a naturopath, this is not part of the theory even suggested by Samuel Hahnemann who is the "Father of Homeopathics". If the purist homeopaths don't consider it to be a relevant alternative, then I can't take it too seriously, either.
My child's healthy. The best defence against disease is a healthy body.
Yes. Of course. But even healthy kids, who have a good diet, and were breast-fed for extended periods still can get sick.
Do you or your child ever get tired, cold, hungry, have a day or a week where your diet is not so good? These are all times that your body's defences may not be at their best. Those times can happen more often on the road.
Diet is such an important factor:
- Will you have access to clean water?
- Are fresh fruit and vegetables going to be plentiful and affordable every where you go?
- Will you always be able to keep up the same quality of diet that you might have been able to at home? In remote Australia, I pay much, much more for fruit and vegetables than I used to in the city so we don't eat as many of them as we probably would have back home. What about where you will be travelling?
Breast feeding protects our kids. Definitely. There is a lot of evidence that breast feeding strengthens a child's immune system.
After six months of age, though, the baby's bowel no longer lets through whole proteins meaning that the antibodies can no longer cross. As the baby's immune system has not been stimulated to make antibodies against those diseases, these wear off in time.
So yes, you can definitely strengthen your baby's immune system. But you cannot provide them with immunity to the disease.
If you could, these diseases would have been eradicated hundreds or thousands of years ago.
It is protective, and gives them an advantage in so many ways, and I would greatly encourage you to breast feed. However, it is not the be all and end all for immunity.
There are lots of ingredients in vaccines
- Yes. There are lots of ingredients in vaccines. There are lots of ingredients in any medicine -- whether it is a tablet or injected. That tablet you are swallowing may contain colours, flavours, talc, lactose ... and much more. Vaccines are the same. These are called excipients. They are all the parts of the medicine that have no action on the body, but are needed to make the medicine stable, attractive, or get into your body.
- Yes, the microbes have to be grown. Some are grown in synthetic cultures. Others are grown in other tissues. The vaccine for Japanese Encephalitis is grown in mouse brain culture. Sounds disgusting, doesn't it? Viruses can't live outside of a cell. To vaccinate against diseases caused by a virus, they must be grown in a cell. That cell can be a chicken egg, or a mouse brain cell. Scientist's use whatever is considered the safest, most effective medium. The virus is then removed from that culture to make the vaccine, but tiny little bits of that culture may remain in the vaccine.
- They contain aluminium and other metals? Yes. These can be found in vaccines. I used to be really concerned about this. Then I found out that there is more aluminium in my diet each day than in one vaccine.
Are these harmful?
Not to the best of our knowledge. The excipients and the vaccines both have to undergo extensive testing and trials to prove that they are safe - first in a laboratory, then on animals, and then small human trials, larger human trials, and then continued monitoring and trialling once it's on the market.
Does this mean that everything that comes to market is guaranteed to be safe? No, of course not.
Think of the times that you've heard or read the news that a drug has been withdrawn due to safety concerns. The longer that something has been on the market, the more likely it is to be safe. And most vaccines have been around a long time. Of course this doesn't mean that some time in the future we won't discover a negative effect from even a vaccine that's been around for years, but the longer it's been on the market the less likelihood of this there is.
The diseases aren't as bad or scary as we're told. Like polio.
The statistic we were told while I was studying naturopathy was this: 90% of people who get polio never even know they've got it. 9% have the symptoms of the common cold. One per cent have paralysis, either permanently or temporarily. This is supported by the Encyclopedia Britannia.
Seriously? I'm going to vaccinate my kid against a rare disease, when only 1% of people end up having any more than the symptoms of a common cold?
I'll take those odds.
In the USA, in 1960, there were 2,525 cases of paralytic polio reported. In 1961, the vaccine was introduced, and by 1965 there were only 61 cases of paralytic polio. Remembering, of course, that the other 99% of those who had the virus probably never even knew they had it. Between 1980 and 1999, there were 152 confirmed cases of paralytic polio. Six of whom had caught it overseas and then come in to the country, and two whom actually seem to have caught the disease naturally. The other 144 cases? That 95% of cases had caught it directly from the vaccine. That weakened virus used in the vaccine had changed back into the live form and the person had come down with polio - at a rate of about eight cases a year.
To me, this is the strongest argument against vaccination. This is fact. It's not a scare campaign. 99% of people who have polio never ever know that they have it. 95% of polio cases since 1980 in the USA have been as a direct result of the vaccine. And you want my kid to have that vaccine?
But ... what I wasn't told when I was studying naturopathy was that the medical profession also thought this was too high. The live oral polio vaccine that they had been using was ceased, and instead an attenuated (weakened) vaccine was brought in. The last vaccine-related polio case was in 1999.
Not one case has been reported with the vaccine that they've used since 2000.
Ok so your family's risk of catching polio and having a serious side effect from the illness is still incrediably low. But the current vaccine is no longer a risk.
There are nasty long term effects from vaccines.
There are lots of rumours. Have you heard the ones about the MMR vaccine causing autism? And the HPV virus causing cancer?
I think there was one that was supposed to cause Mad Cow Disease, too -- in the 1960s, before they'd even discovered a protein-based thing called a prion that causes the disease. Anyway, back to the 21st century ...
Yes, there are rumours and suggestions. There is no evidence to support them.
I guess this one comes down to what scares you more? The rumoured potential for a long term side effect, or documented evidence of potential concerns from the disease? To be fair, with a vaccine you are guaranteed to have the vaccine, with the disease you are not guaranteed to have it.
The Australian government have produced a booklet, if you are interested in reading further about the arguments and counter-arguments. Obviously, as a government publication, it is pro-vaccine and entitled "Myths About Vaccination".
Who cannot have vaccines?
Anyone with anaphylaxis to a previous dose of the vaccine, or any of the ingredients should be considered to have a contraindication. The rabies, yellow fever, and influenza vaccines are grown in egg protein - they are usually not be given to anyone who has an anaphylactic reaction to eggs.
There are certain vaccines that are considered 'live' vaccines. These are vaccines where the virus is said to be 'attenuated' or weakened so it cannot cause disease any more, but the body will still react to it to stimulate an immune response. These are the MMR (measles mumps rubella), chicken pox, yellow fever, rabies, BCG, and typhoid vaccines. These vaccines are contraindicated in any one with impaired immunity, whether it is from a disease or treatment. Pregnant women or those trying to conceive should not have these either. People should be careful not to conceive within four weeks of having the immunisation.
What are not considered contraindications? Having a fever below 38.5C is not a contraindication, nor is a personal history of convulsions or family history of adverse reactions to vaccines. Treatment with antibiotics, inhaled or topical steroids are not, nor is replacement corticosteroid therapy. Some of these may medically need a delay in the dosing of the vaccine, but are not contraindications.
If you are concerned about any of these, please talk to your doctor to find out information specific to your own situation.
What are the recommendations for travel?
I apologise for the uni-national flavour of this section. As an Australian pharmacist, I am only really aware of Australian recommendations. Maybe you could let us know if the recommendations from your country are different? Hepatitis A and pneumococcal, for example,are only routine vaccinations in Australia for Aboriginal and Torres Strait Islander children, rather than all children. I have still included them as usual scheduled vaccines.
There are the usual scheduled vaccines for children in Australia that may need boosters:
Measles - Those born during or since 1966 who have not received 2 doses of MMR should be vaccinated.
Varicella - offered to all those who have not had the clinical disease.
Tetanus - should receive diptheria and tetanus combined vaccination if it has been over 10 years since the last dose. Can be pertussis, diptheria and tetanus instead if no previous dose of pertussis has been given during adulthood.
Polio - boosters are not required, unless visiting a region where wild polio virus still exists (Afghanistan, India, Nigeria or Pakistan).
Pneumococcal - Those with any medical risk factors or of over 65 should be vaccinated. This is part of the normal schedule for Aboriginal and Torres Strait Islander children in Australia.
Meningococcal - All children and teenagers would have had this included in the Australian vaccination schedule. Recommended for all travelling to sub-Saharan Africa, and Delhi, India due to large epidemics in 1966, 1985 and 2005. Saudi Arabian authorities mandate all pilgrims to the annual Hajj have evidence of recent vaccination.
Hepatitis B - part of the routine Australian schedule for children now. Adults are recommended to complete a course due to risk in planned or unplanned medical procedures, or if spending a month or more in Central and South America, Africa, Asia or Oceania.
Hepatitis A - Again, part of the normal schedule for Australian Aboriginal and Torres Strait Islander children. Also recommended for those over 1 year travelling to moderate to highly endemic countries, including all developing nations.
Now for the travel specific ones (for Australians)
Typhoid - to all travellers aged two years or more, travelling to endemic regions, including Indian subcontinent, most southeast Asian countries, many south Pacific nations and Papua New Guinea.
Cholera - Rarely indicated. The risk of catching it is low, and protection offered is relatively short. Travellers at considerable risk such as those working in humanitarian disaster situations could be considered for it. Global certification for it has been abandoned.
Rabies - Travelling to endemic regions should avoid close contact to wild and domestic animals. Vaccination simplifies the management if a bite from an infected animal does occur.
Japanese Encephalitis - recommended for those spending a month or more in rural areas of Asia or Papua New Guinea, particularly during the wet season. Also recommended for those spending a year or more in any part of Asia.
Yellow Fever - WHO no longer reports on this. Recommended for those travelling to Yellow Fever endemic countries. Vaccine can be given to all from 9 months old if they are travelling to any country in West Africa.
Tuberculosis - Given to children under five years who will be living in developing countries for more than three months. Limited evidence of the benefit for older children and adults, though vaccination may be considered for those over 16 spending extended periods in at-risk areas.
So do I vaccinate my family before travel?
Before you make a decision whether to vaccinate or not, take the time to look at your intinery and consider the various diseases your family might be exposed to. How serious are these diseases and the side effects? How prevalent are they? Can you avoid exposure by not going into certain areas or avoiding outbreaks, or is the disease more wide spread or harder to predict? What treatment is available in the countries that you are visiting?
Like everything else with parenting, the facts are often murkied with emotional propoganda. Both the pro and anti vaccine debate use fear -- preying on our natural fears and aprehensions as parents. Which are you more scared of? Potential side effects from the vaccine or potential complications from the disease?
By all means, you should consider the potential side effects of the vaccinations themselves and plan other ways to maximise your family's health on the road. Just take the time to look at each disease seriously. Consider the severity and prevalence, as well as the various prevention options before ruling out vaccination.
Of course, this article does not replace getting specific medical advice from your doctor. There may be reasons why a particular vaccine that is or is not recommended for you. Those considerations go beyond the scope of a general article such as this.