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Vaccines: Still Key to Child and Community Health

A shift in public perception about vaccine safety threatens the success of immunization programs.

Vaccines are one of the greatest advances in medical history. In just the past 50 years, polio, measles, rubella, mumps, and Haemophilus influenzae type B disease have nearly disappeared in the U.S. A group of experts has reviewed the history of immunizations in the U.S., the evidence that supports immunization requirements, and current threats to our successful immunization program. Their report includes the following:

• In 1969, 17 states had laws that required immunization for school entry; by the early 1980s, all 50 states required immunization.
  
• Rates of nonmedical exemptions (because of religious, philosophical, or personal beliefs) for required school immunizations increased from about 1% in 1991 to 1.5% to 2.5% in 2004. The exemption rate for religious reasons during this period remained at about 1%.
  
• Concern about safety is the principal reason parents refuse immunizations.
  
• Increasingly, parents are choosing to delay vaccination of their children or follow alternate vaccine schedules rather than schedules recommended by expert committees.
  
• Unvaccinated children are significantly more likely to contract measles and pertussis than vaccinated children.
  
• Compared with undervaccinated children, unvaccinated children are more likely to be white, live in higher-income households, and have a married mother with a college education.
  
• Parents continue to report that healthcare providers are the most frequent source of information about immunizations.
  

The AAP Committee on Bioethics advises against discontinuing care for families that refuse vaccines, yet 40% of pediatricians report that they would no longer provide care to families who refuse all vaccines.

Comment: During the past 10 years, new vaccines have been introduced at a dizzying pace. Is vaccine fatigue — among both parents and physicians — affecting immunization rates? The childhood immunization schedule used to be relatively easy to follow. Now, three separate schedules exist, each with detailed comments (http://www.cispimmunize.org/IZSchedule_Childhood.pdf, http://www.cispimmunize.org/IZSchedule_Adolescent.pdf, and http://www.cispimmunize.org/IZSchedule_Catchup.pdf). Simultaneous increases in the number of immunizations and rates of autism and allergic diseases have fueled concerns about a link between these conditions and vaccines, despite no credible evidence of an association. The more knowledgeable we are about possible safety issues, the better we can address parental concerns (JW Pediatr Adolesc Med Jan 28 2009). As we move toward a more complicated adolescent vaccination schedule, further adherence issues will arise, particularly because most adolescents visit their primary care provider less than once each year. I can envision a time when immunizations will be required for high school graduation just as they are for school entry. In view of the shift in perception about the safety of vaccines, we must remind our patients — and ourselves — that immunizations are responsible for saving more lives than virtually any other medical advance.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine May 6, 2009

Citation(s):

Omer SB et al. Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. N Engl J Med 2009 May 7; 360:1981.

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Reader Remarks:

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• Polio disappeared naturally
  Cathy Sherman, 7 May 2009 1:47 AM EST
  Records show polio disappeared in Europe in the 40’s and 50’s despite there being no “immunizations”.
• Vaccines
  Gilbert Z. Given, 7 May 2009 12:51 PM EST
  Although the AAP Bioethics Committee advises against refusing care to families that refuse vaccinations, various AAP chapters have adopted an... [more]
• Polio disapeared naturally
  David A Deitsch, 7 May 2009 4:25 PM EST
  Cathy, what records would those be? I have a degree in history, with a fairly good background in medical history,... [more]
• The health of unvaccinated children
  Sue Claridge, 7 May 2009 4:57 PM EST
  If the medical establishment really wanted to understand the difference in health between vaccinated children and those who are unvaccinated... [more]
• Polio Disappeared Naturally
  Josh Parker, 7 May 2009 4:57 PM EST
  Cathy,
  
  I would also be very interested to hear more about polio DISAPPEARING in the 40s and 50s. Was there... [more]
• Vaccine Refusal
  Howard Bauchner, MD, Boston University School of Medicine/Boston Medical Center, 8 May 2009 10:59 AM EST
  I appreciate the various comments. Polio, like many other infectious diseases declined before the introduction of the vaccines. However, most... [more]
• Vaccine safety issues
  Patrick Hurly, 8 May 2009 2:13 PM EST
  "Simultaneous increases in the number of immunizations and rates of autism and allergic diseases have fueled concerns about a link... [more]
• health of unvaccinated children
  Laurie J Redmon, 10 May 2009 8:14 PM EST
  The Amish community does not vaccinate their children. Many families who have already have a child with autism do not... [more]
• Polio Disappeared Naturally ?
  Nelson M Leite, Sao Paulo Federal University, 12 May 2009 5:15 AM EST
  I'm a MD in Brazil and when acting as orthopedic consultant I diagnosed cases of acute poliomyelitis around the 1976... [more]
• Vaccination Data
  Nancy Smith, 12 May 2009 9:50 AM EST
  As a pediatric nurse, I have cared for children who contracted vaccine preventable diseases and seen the devastation of those... [more]
• The Medicine advances
  NM Leite, Federal university of Sao Paulo - Brazil, 13 May 2009 8:14 PM EST
  When I intellectually discuss any aspect of advances in the medicine I ever remember the people that are opponent to... [more]
• Bauchner vaccination comment
  C.A. Porubsky, 1 Aug 2009 1:51 PM EST
  What a ridiculous and offensive comment, clearly inferencing mandatory vaccinations for graduation or being able to function in society. Where... [more]