What you should know: Stating facts and dispelling myths about vaccines
Special to the Daily
Vaccination requirements for Colorado kids
Colorado law requires all students attending Colorado schools and licensed child cares to be vaccinated against certain diseases, unless an official exemption form is filed, citing medical, religious or personal beliefs for not vaccinating.
Vaccines required to enter child care:
• Hepatitis B
• Diphtheria, tetanus, pertussis (DTap)
• Haemophilus influenza type b (Hib).
• Inactivated poliovirus (IPV)
• Pneumococcal conjugate (PCV13) or polysaccharide (PPSV23)
• Measles, mumps, rubella (MMR)
• Varicella (chicken pox)
Vaccines required to enter school (kindergarten through 12th grade):
• Hepatitis B
• Diphtheria, tetanus, pertussis (DTap)*
• Inactivated poliovirus (IPV)*
• Measles, mumps, rubella (MMR)*
• Varicella (chicken pox)*
• Tetanus, diphtheria, pertussis (Tdap)**
*Students ages 4 to 6 are required to have their final doses of DTaP, IPV, MMR and Varicella prior to kindergarten entry.
**Students are required to have Tdap prior to entry into sixth grade. One dose of Tdap is required for sixth through 12th grades.
Source: Colorado Department of Public Health & Environment (www.colorado.gov)
Editor’s note: This story has been updated, as it contained incomplete information. According to the Colorado Department of Health & Environment, there is a list of vaccines required for students to attend Colorado licensed child cares and schools. However, parents can file an official exemption form, citing medical, religious or personal beliefs for not vaccinating their children, and those children will still be allowed to attend. Students with an exemption from one or more required vaccines may be kept out of a school or child care during a disease outbreak. For more information, search “Vaccines” at http://www.colorado.gov.
It wasn’t long ago that the measles was a common childhood affliction.
According to the Centers for Disease Control and Prevention, from the early 1950s to the early 1960s, nearly all children got the measles — a highly contagious virus that is spread through coughing and sneezing and is characterized by a rash covering the entire body — by the time they were 15 years old and an estimated 3 million to 4 million people in the United States were infected each year.
It is estimated that 400 to 500 people died from the measles each year during that decade, 48,000 were hospitalized and 4,000 suffered from encephalitis (swelling of the brain) as a result of the disease. Today, however, most doctors never see even a single case of the measles, with cases having been reduced by more than 99 percent since the vaccine, which was first introduced in 1963, gained widespread use.
The disease was declared eliminated — meaning the absence of continuous disease transmission for 12 months or more in a specific geographical area — from the United States in 2000.
According to the CDC, other diseases, such as whopping cough, polio, diphtheria and rubella, which were all as common and as contagious as the measles, previously afflicted hundreds of thousands of infants, children and adults in the United States and caused thousands of deaths.
Rates of these diseases also declined, until most of them were eliminated or nearly eliminated following the development and widespread use of vaccinations.
“I don’t see the same things I used to see,” said Dr. Leslie Fishman, a pediatrician at Colorado Mountain Medical, who has been in practice since 1982. “I don’t see things like meningitis or other serious diseases that can cause death. (Vaccinations) have made children’s health so much better; they have changed public health and personal health dramatically.”
Fishman also noted that he has seen a decrease in patients with rotavirus, which, according to the CDC, is an intestinal infection that spreads easily among infants and young children. The virus can cause severe, watery diarrhea, vomiting, fever and abdominal pain. Children who get rotavirus disease can become dehydrated, and may need to be hospitalized.
The rotavirus vaccine that is widely used today first became available in 2006. The CDC reports that each year before the vaccine was available, more than 400,000 young children had to see a doctor for an illness caused by rotavirus, more than 200,000 had to go to the emergency room, 55,000 to 70,000 had to be hospitalized and 20 to 60 died. Since the introduction of the rotavirus vaccine, hospitalizations and emergency room visits for rotavirus have dropped dramatically.
Fishman reports witnessing this decline in his own practice.
“I haven’t had to put a kid in the hospital for rotavirus in six or seven years,” he said. “It’s disappeared since the vaccine; I haven’t seen anyone with it recently.”
Understanding herd immunity
Despite the decrease in previously prevalent contagious diseases such as rotavirus or the measles, concerns about the safety of vaccinations have risen throughout the past two decades. Anti-vaccination advocates question whether vaccinations deserve the credit for the decrease in infectious disease, or if the decrease is more likely the result of improved hygiene and sanitation.
According to the World Health Organization, though, while improved socioeconomic conditions throughout time have no doubt impacted rates of disease, the most dramatic shifts, when looking at incidence of a disease throughout time, happen in relation to the introduction of a vaccine. In the case of the measles, for example, there have been periodic peaks and valleys throughout the years, but the real, permanent drop in measles cases coincided with the licensure and wide use of the vaccine.
The concept of herd immunity, said Dr. Eric Olson, a family medicine physician at Colorado Mountain Medical who has been in practice for 18 years, helps explain why vaccinations remain important in controlling future outbreaks of infectious disease.
“Herd immunity is when an illness meets a community … if a certain percentage of the community has been vaccinated or has developed the antibody, then the chance of the illness being able to propagate through that community is lessened; it makes it harder for that virus to spread,” Olson said. “It also helps protect people who, for whatever reason, can’t get an immunization, like women who are pregnant or people who have a serious illness or weakened immune systems and can’t obtain a vaccination as a result.”
Questions about vaccine safety
Still, concerns persist. One need only spend a few minutes on the internet to find hundreds of websites and articles about the potential dangers of vaccinations. Commonly cited concerns include the risk of serious side effects, the possible toxicity and subsequent safety of the ingredients used in vaccinations and potential links to learning disabilities, asthma, autism, diabetes, chronic inflammation and other disabilities.
“The biggest myth (about vaccinations) awhile back was the connection to autism,” Olson said. “And, frankly, that seems to have been put to rest with Andrew Wakefield’s fall from grace.”
Wakefield was a gastroenterologist who, in 1998, published a study with 12 other co-authors in the British medical journal The Lancet, which claimed to find evidence of measles in the digestive systems of children who had exhibited symptoms of autism after having the measles, mumps and rubella vaccination (commonly known as the MMR vaccination).
Subsequent studies, however, failed to replicate the findings, and in 2004, The Lancet revealed that Wakefield had been paid by attorneys seeking to file lawsuits against vaccine manufacturers. The study has since been removed from The Lancet’s archives.
“I think probably now the biggest thing that parents will talk to me about is the trace elements that are found in vaccinations and the potential danger that they may pose,” Olson said. “These are things that are found in vaccinations, they are part of the manufacturing of the vaccinations, but these are things that are in trace quantities in the vaccinations and, really, your body can deal with them in the vaccination and they don’t cause any harm to the patient receiving the vaccination.”
While some parents are choosing to forgo vaccinations altogether in order to avoid these and other potential risks, others are exploring alternative vaccination schedules, which propose a more gradual pace for vaccinating children than the CDC’s recommended schedule. The most popular of these alternative schedules was developed by California pediatrician Dr. Robert Sears, who introduced his alternative schedule in his 2007 book “The Vaccine Book: Making the Right Decision for Your Child.”
In a 2010 interview with the PBS documentary series “Frontline,” Sears explained why he developed an alternative vaccination schedule.
“I see a lot of parents questioning the CDC vaccine schedule,” Sears said in that interview. “They worry that it’s too overloaded. There’s too many shots at too young of an age, and parents simply are looking for a safer way to do it, something they’re more comfortable with.
“I created my alternative vaccine schedule that allows parents to go ahead and vaccinate, simply in a more gradual manner. And I find a lot of worried parents who otherwise would refuse vaccines altogether are very happy to go ahead and vaccinate if they’re doing it in a way that they feel safer about.”
Olson said that if a parent asks, he would talk through the details of an alternative vaccination schedule, but that his preference is to stick to CDC guidelines.
“The vaccination schedule that’s been put forward by the CDC is a way of getting the most vulnerable people, being kids, protected in that first part of their life when they have a developing immune system,” Olson said. “It helps them develop antibodies to be able to fight off potentially devastating illnesses.
“The problem with following the alternative schedules is the potential delay in getting the vaccination, and the vast majority of the time that’s probably not going to cause an issue. But all the same, the schedule that’s been put out (by the CDC) has been vastly safe and gets young children vaccinated in a very safe and timely fashion.”
Olson urges parents who might have concerns or questions about vaccinations to ask questions.
“I think that doctors realize that parents are always trying to make the best decision for their kids,” Olson said. “And I think that myself and the doctors I work with, we’re very cognizant of that. We want to be supportive of helping a parent make the best decision.
“But we also want to do our best to protect the child, and sometimes, you know, there can be some butting of the heads between parents and physicians when we’re talking about that. But it’s never a bad thing to ask questions to your doctor.”