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August: National Immunization Awareness Month

This month is National Immunization Awareness Month, a time to recognize the importance of our routine vaccinations and the impact that vaccinations have had globally and historically.[1]

A vaccine is a “biological agent that stimulates a person’s immune system to produce immunity to a specific pathogen.”[2] Since 1798, when Edward Jenner published his work on the development of a vaccine against smallpox, vaccinations have become an important public health tool to prevent illness, disability, and death from diseases such as diphtheria, hepatitis B, measles, mumps, pertussis (whooping cough), pneumonia, polio, rotavirus diarrhea, rubella and tetanus.[3], [4] The World Health Organization (WHO) estimates that 2 to 3 million deaths are prevented every year due to immunizations, and an additional 1.5 million deaths could be averted with expanded global coverage.[5]

In the United States, we have a series of recommended immunizations that are spelled out for each population group. Children from birth to six years old should receive vaccinations for chickenpox, diphtheria, meningitis, influenza (flu), measles, mumps, pertussis, polio, pneumococcal, rotavirus, rubella, and tetanus.[6] As we age, the Centers for Disease Control and Prevention (CDC) recommends booster shots, as immunity can fade over time and we become more susceptible to disease.[7] Each state has specific vaccination requirements for a child’s entry into school, yet all states provide medical exemptions. Some states also offer additional exemptions from vaccinations for religious or philosophical reasons. However, studies have shown that these exemptions tend to cluster in geographic areas, which increases the risk for outbreaks in these communities.[8]

This “anti-vaccination” movement consists of skeptical parents that distrust the federal government and pharmaceutical companies, or believe that vaccinations such as the Measles, Mumps, and Rubella (MMR) vaccine can cause autism. Although the 1998 report that claimed a link between the MMR vaccine and autism has been debunked, and the lead author stripped of his medical license, parents continue to be doubtful.[9] Parents choosing not to vaccinate their children are unwittingly allowing diseases to return to cities of our nation, measles most notably. The U.S. experienced 11 measles outbreaks in 2013, 23 outbreaks in 2014, a multi-state outbreak in 2015, and, from January 2 to July 22, 2016, 48 measles cases have been reported.[10] The year 2014 saw a record 644 cases since measles was declared eradicated in the U.S. in 2000.[11] A majority of these cases occurred in unvaccinated individuals. In 2013, California had a record number of kindergarteners not vaccinated for philosophical reasons: 14,921.[12] This is especially concerning considering these unvaccinated individuals tend to live in close proximity. An American Academy of Pediatrics study found that five counties in California had the highest rates of unvaccinated children, which increased from 18% to 23% among children who turned 36 months old between 2010 and 2012.[13] In the Westside of Los Angeles, some schools have 60-70% of parents submitting personal belief exemptions for their children.[14]

To maintain high vaccination coverage, states should consider establishing stricter vaccination requirements and exemption application processes, and developing stronger healthcare practices that engage hesitant parents.[15] About 79% of doctors believe that unvaccinated children should not be allowed in schools, and some doctors are even taking action of their own and will not accept new patients that do not plan on receiving standard immunizations.[16] In 2015, California passed a bill (effective July 1, 2016) that will make vaccines mandatory for nearly every child, only allowing exemptions for medical reasons.[17] California joins Mississippi and West Virginia as the only states that do not allow religious or personal belief exemptions.[18]

However, improper vaccination is not only an issue of mistrust. Unvaccinated children may have parents that are wary of vaccinations, or doubt their necessity, while undervaccinated children may live in circumstances that do not permit timely or complete vaccination receipt. Poorer or underserved communities may have inadequate transportation, limited clinic hours, a lack of information about vaccines, or language barriers that make full vaccination coverage difficult.[19]

Vaccine hesitancy is not solely a national phenomenon. In India, there is a resistance to new vaccines that are not manufactured by Indian suppliers.[20] In Kenya, catholic bishops opposed a WHO-led tetanus vaccination campaign because these bishops believed the vaccines were “laced” with a birth-control hormone, and that the Catholic Church had not been given “adequate stakeholder engagement.”[21] In Bulgaria, undervaccination in the Roma (a nomadic ethnic group) population has largely been due to a lack of immunization programs that are welcoming to Roma.[22] Moreover, rumor and misinformation have spread the misconception that microcephaly caused by Zika is instead a result of the Tdap vaccine given to pregnant women to prevent tetanus, diphtheria, and pertussis.[23] These global examples further highlight the need to address not only the barriers to receiving vaccination care, but also the lack of information that may exist surrounding vaccines.

To date, smallpox, which historically killed up to 35% of its victims, is the only disease that has been globally eradicated using vaccines.[24] However, before standard vaccine use, diseases like whooping cough, polio, measles, and rubella killed thousands each year.[25] A rubella epidemic in 1964-65 infected 12.5 million Americans, killed 2,000 infants, and caused 11,000 miscarriages, yet, due to vaccinations, only nine cases of rubella were reported in 2012.[26] In 1921, before there was a vaccine, more than 15,000 Americans died from diphtheria, but only one case has been reported to the CDC since 2004.[27] As a result of standard vaccine use, these diseases that were once widespread have almost disappeared.

Vaccinations are not just important for your own, individual health. Herd immunity occurs when a “critical portion of a community is immunized against a contagious disease,” so the rest of the community is protected as there is little opportunity for an outbreak.[28] We must maintain high vaccination rates in order to protect the vulnerable, and those that are unable to get vaccinated due to medical reasons. You may not always know when you are sick, and could be contagious without realizing it. Furthermore, if even just a couple of disease cases are introduced into a community where a many people are unvaccinated, an outbreak can occur.[29] Nationally, if vaccination rates drop, diseases could become just as common as they were before vaccines. Although the youth of today have enjoyed a life without the diseases of previous generations, it is important not to disregard the importance of these routine vaccines, or forget the devastating effect these diseases can have during an outbreak.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[1] “Recognizing National Immunization Awareness Month (NIAM),” Centers for Disease Control and Prevention, last updated June 28, 2016, accessed August 10, 2016, http://www.cdc.gov/vaccines/events/niam.html.

[2] Natalia Reagan, “Talking Science: Facts About Vaccines and Herd Immunity,” The Huffington Post, April 26, 2016, accessed August 10, 2016, http://www.huffingtonpost.com/natalia-reagan/the-true-facts-about-vaccines-and-herd-immunity_b_9775386.html.

[3] “Vaccine Timeline,” Immunization Action Coalition, last updated June 14, 2016, accessed August 10, 2016, http://www.immunize.org/timeline/.

[4] “Immunization coverage,” World Health Organization, updated July 2016, accessed August 10, 2016, http://www.who.int/mediacentre/factsheets/fs378/en/.

[5] “Immunization coverage,” WHO.

[6] “2016 Recommended Immunizations for Children from Birth Through 6 Years Old,” Centers for Disease Control and Prevention, last updated January 2016, accessed August 10, 2016, https://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdf.

[7] “Immunization Schedules for Adults in Easy-to-read Formats,” Centers for Disease Control and Prevention, last updated February 29, 2016, accessed August 10, 2016, https://www.cdc.gov/vaccines/schedules/easy-to-read/adult.html.

[8] “State Vaccination Requirements,” Centers for Disease Control and Prevention, last updated January 29, 2016, accessed August 10, 2016, http://www.cdc.gov/vaccines/imz-managers/laws/state-reqs.html.

[9] Kimberly Leonard, “What’s Really Behind the Measles Outbreak,” US News, January 26, 2015, accessed August 10, 2016, http://www.usnews.com/news/blogs/data-mine/2015/01/26/whats-really-behind-the-measles-outbreak.

[10] “Measles Cases and Outbreaks,” Centers for Disease Control and Prevention, last updated July 20, 2016, accessed August 10, 2016, http://www.cdc.gov/measles/cases-outbreaks.html.

[11] Leonard, “What’s Really Behind the Measles Outbreak.”

[12] Yamiche Alcindor, “Anti-vaccine movement is giving diseases a 2nd life,” USA Today, April 8, 2014, accessed August 10, 2016, http://www.usatoday.com/story/news/nation/2014/04/06/anti-vaccine-movement-is-giving-diseases-a-2nd-life/7007955/.

[13] Leonard, “What’s Really Behind the Measles Outbreak.”

[14] Reagan, “Talking Science: Facts About Vaccines and Herd Immunity.”

[15] “State Vaccination Requirements,” CDC.

[16] Kyle McCarthy, “8 Eye-Opening Facts About Vaccines,” The Huffington Post, February 9, 2015, accessed August 10, 2016, http://www.huffingtonpost.com/kyle-mccarthy/8-eyeopening-facts-about-_b_6633786.html.

[17] Lydia O’Connor, “Mandatory Vaccine Bill Passes in California,” The Huffington Post, May 15, 2015, accessed August 10, 2016, http://www.huffingtonpost.com/2015/05/14/california-vaccine-bill-passes-senate_n_7286274.html.

[18] McCarthy, “8 Eye-Opening Facts About Vaccines.”

[19] Yujia Pan, “Here’s What Low-Income Families Think About Mandatory Vaccination,” The Huffington Post, July 10, 2015, accessed August 10, 2016, http://www.huffingtonpost.com/2015/07/09/california-mandatory-vaccination_n_7765492.html.

[20] Teresa Welsh, “Anti-Vaccine Movements Not Unique to the U.S.” US News, February 18, 2015, accessed August 10, 2016, http://www.usnews.com/news/articles/2015/02/18/anti-vaccine-movements-not-just-a-us-problem.

[21] Welsh, “Anti-Vaccine Movements Not Unique to the U.S.”

[22] Welsh, “Anti-Vaccine Movements Not Unique to the U.S.”

[23] Deena Zeplowitz, “When Zika Turns Deadlier: How Anti-Vaccination Misinformation Could Exacerbate an International Health Emergency,” The Huffington Post, February 29, 2016, accessed August 10, 2016, http://www.huffingtonpost.com/deena-zeplowitz/when-zika-turns-deadlier-how-anti-vaccination-misinformation-could-exacerbate-an-international-health-emergency_b_9320638.html.

[24] “Disease Eradication,” The History of Vaccines, last updated January 25, 2016, accessed August 10, 2016, http://www.historyofvaccines.org/content/articles/disease-eradication.

[25] “What Would Happen If We Stopped Vaccinations?” Centers for Disease Control and Prevention, last updated May 19, 2014, accessed August 10, 2016, http://www.cdc.gov/vaccines/vac-gen/whatifstop.htm.

[26] “What Would Happen If We Stopped Vaccinations?” CDC.

[27] “What Would Happen If We Stopped Vaccinations?” CDC.

[28] Reagan, “Talking Science: Facts About Vaccines and Herd Immunity.”

[29] “What Would Happen If We Stopped Vaccinations?” CDC.

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