A Question Of Immunity

Vaccines work wonders against deadly diseases, but some parents want to know: Are they safe for everyone?

October 24, 1999|By Sara Wildberger | Sara Wildberger,SPECIAL TO THE SUN

Diphtheria, polio, whooping cough: They're diseases of long ago. In the current spate of summaries of 20th-century news, we see old photographs of grieving parents, and long wards filled with iron beds and suffering children. But the next picture is likely to be a line of children waiting to get the new vaccine, and smiling parents.

Most people now take vaccines for granted. They got their shots, their children get their shots, and the shots work. The fatal epidemics of the past don't happen anymore. The last reported case of diphtheria in Maryland was in 1973. There was one case of measles last year; no polio.

But Dr. Neal Halsey, director of the Institute for Vaccine Safety at the Johns Hopkins School of Public Health, has seen what such diseases do. "The organisms that cause these diseases still exist in this country," he says. "If people stopped getting immunized, no question we'd have recurrences. "Young parents haven't seen [the diseases], so they no longer have the fear. But for people like myself who've seen children suffer and die from these diseases, there's no question: We must immunize."

But increasingly vocal groups of parents and others have a different view. They don't see the damage of the diseases, but they're too familiar with injuries caused by, or believed to be caused by, vaccines. More and more often, they're taking their cause to Congress and the media.

The most visible of these is Barbara Loe Fisher of Vienna, Va., who believes her son's learning disabilities were caused by a vaccine reaction. She has become an activist, founding the National Vaccine Information Center and co-writing the book "A Shot in the Dark," about issues around the DPT vaccine.

"Parents are instinctively starting to question why children need all these vaccines. I'm not saying parents don't want to vaccinate -- most want to, but they want to do it safely. They want flexibility on timing and on the number of vaccines," Fisher says.

"Before we add more vaccines into this mix we have to do scientific research into this and find out whether there are dangers. The breach of trust occurring here on this issue threatens trust in all of health care."

Like Fisher, many groups are careful to say they are not "anti-vaccine" but "pro-choice," and that they only advocate further research and education in the interest of children's safety. But others aren't so careful -- and there's enough misinformation out there to confuse any parent.

The nation's childhood immunization coverage is the highest it's ever been: 80 percent. Maryland's is 80 percent as well, and state health officials haven't seen an increase in requests for exemptions from required vaccinations.

Still, the vaccine anxiety has doctors worried. The last time it swelled up, there was a 10 percent dip in immunization levels, one factor that led to a nationwide measles epidemic between 1989 and 1991, according to the Centers for Disease Control and Prevention. In Maryland, 544 cases were reported and one out of five ended up in the hospital; nationwide, there were about 55,000 cases and 120 deaths.

The issue of vaccine safety is as old as the smallpox vaccine, developed in the 18th century. Because the vaccine was formed from the cowpox virus, "there were people concerned that the vaccine would turn them into cows," Halsey says.

"But even back then, there were some people who had very bad reactions to it. There are adverse reactions now, and I don't want to minimize their seriousness at all. But these are very rare."

A few recent headline-grabbing vaccine issues also served to shake some parents' trust in immunization: The CDC called on doctors to use the killed polio vaccine, because the live oral vaccine was linked to development of polio in 10 children. The DPT shot, believed to have caused adverse reactions, was replaced by the safer DtaP vaccine.

And two items came in July: The preservative thimerosal, used in many vaccines, has a trace of mercury, which, theoretically, might cause harm. The American Academy of Pediatrics recommended that doctors wait until children are a few months older before giving the Hepatitis B vaccine, and asked manufacturers to quit using thimerosal.

Then a vaccination program against rotavirus, an infection that causes infant dehydration and death, was suspended after reports that it might have harmed 20 children. The vaccine was taken off the market Oct. 15.

No one at the CDC or at any major medical institution denies that serious adverse reactions to vaccines do occur. The difficult part is separating an injury caused by a vaccine from a disorder that a child would fall prey to for any other reason.

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