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September 18, 2000
Your Child's Best Shot
Clarifying misconceptions about immunization
By Jonathan Freedhoff, M.D.

Illustration: Terrie Maile

When one of my patients told me she did not want her son to be immunized, I was taken aback. It had never occurred to me that a parent would not want this protection for her child. I asked why, and she told me that she had read some scary information about vaccinations -- something about them causing brain damage and other problems. I urged her to show me the information so I could see exactly what she was worrying about. She did, and together we discussed some common misconceptions about vaccinations, as well as some facts about vaccine-preventable diseases (VPDs).

Misconception 1: Vaccines simply do not work -- people are still getting the diseases for which they've been vaccinated.

Facts: No vaccine is 100 percent effective. However, trials of all the routine childhood vaccines show them to be highly effective in preventing disease, with efficacies ranging from 80 percent to virtually 100 percent.

Misconception 2: Most VPDs have been eliminated from North America; therefore, I do not need to vaccinate my child.

Facts: While it is true that vaccination has led to extremely low levels of VPDs in the United States, VPDs have not disappeared from the planet. They are not only prevalent in other parts of the world, some are epidemic -- and travelers can unwittingly spread them across the globe. Without vaccinations, these diseases would run rampant in every country, causing significant illness and death. A recent example of this would be the 1989-1991 measles outbreak in the United States. There were 55,000 cases of measles and 132 deaths, with the deaths occurring mainly among unvaccinated babies and toddlers.

Misconception 3: Before the advent of vaccination, VPDs were already disappearing due to improved hygiene and sanitation.

Facts: There is no question that improvements in living conditions have led to better health and to significant disease prevention. That being said, VPDs have not been eradicated, and in populations of children who, for various reasons, have not been immunized there have been fatal outbreaks of all VPDs, regardless of living conditions. In the United States, for example, prior to the use of the Haemophilus influenzae type b (Hib) vaccine in 1991 to prevent meningitis, there were approximately 20,000 cases and roughly 1,000 deaths every year. Today, nine years after initiating Hib vaccinations, and with no changes in our living conditions, there are only a few hundred cases and only a handful of deaths annually.

Misconception 4: Vaccines can lead to brain damage, autism, inflammatory bowel disease, and other horrible illnesses.

Facts: Because vaccinations are given throughout early childhood, certain other diseases or conditions that manifest themselves during the same period in a child's life may be inappropriately associated with vaccination. This is especially true when the disease or condition in question does not have a satisfactory medical explanation. Autism, convulsions, and sudden infant death syndrome are all conditions which, to date, have no obvious cause and most commonly develop during the years children receive vaccinations.

sidebar: Risks and Complications from Vaccine Preventable Diseases

Does this mean that vaccinations cause these conditions? No. In fact, the so-called link between the measles/mumps/rubella vaccine and autism and inflammatory bowel disease came from a paper published in 1998 in which the authors themselves stated the following: "Published evidence is inadequate to show whether there is a link with measles mumps, and rubella vaccine." Soon thereafter, a 14-year study clearly demonstrated that there was no link.

In addition, the alleged link between the old vaccine for whooping cough (a new one is being used now) and potential brain damage was from a paper written in the 1970s that has never been validated by any other study.

Truth versus fiction

It's true that vaccines have side effects, but most are minor and temporary, such as a sore arm where the shot was given or a low-grade fever. These side effects can often be prevented or controlled simply by giving your child some acetaminophen just before or just after the vaccination. Serious adverse effects are extremely rare, occurring in approximately one in a million cases. When compared with the overwhelming risk of serious illness and death from the diseases themselves, the risk of side effects from vaccines is insignificant.

Immunization has been one of medicine's greatest triumphs, having saved millions of lives. Before dismissing vaccinations as dangerous, make sure you understand the risks involved in refusing them. Lastly, if you have any questions about immunization, please discuss them with your doctor.

Related links: feature article: Tick Check: New Recommendations for Preventing Lyme Disease

Outside link: Vaccination Resource Center from the American Academy of Pediatrics

Outside link: Information on vaccine safety from the U.S. Food and Drug Administration

Outside link: Current recommended immunization schedule from the American Academy of Pediatrics