Health Issue: The Debate on Vaccinations

Current Trend in Health Care: MMR Vaccines

• Brittany Core

Nothing is more heartbreaking than a young life that has been taken by the infection of a killer disease. Diseases kill children every year. Many diseases are bacteria, inhaled by the victim, infecting several areas of the body. The bacteria lives and grows while its victim dies. Other diseases are caused by viruses; a non-living infection that attacks the immune system and other living cells. Children are much more vulnerable to disease because of their weak immune systems. They’re weak because they have not lived life long enough to build immunities for such infections. However, in medicine, there are always risks. So, parents argue that vaccinations should not be mandatory for children.

For many years, immunizations have continued to keep the spread of disease low. They have lowered the amount of deaths and saved lives. On the other hand, what if it was against families’ religion or they say their child is a “tough one” and they can handle the severe symptoms of disease? Those are the arguments made by people who believe that vaccines should not be mandatory for children. Are those arguments strong enough to counter all the children’s lives that have been saved by intelligent medicine? Unless America wants to unleash the beast of infectious killers, vaccinations for children should be mandatory to keep it from spreading and eventually killing. Research shows that the benefits of vaccination outweigh the risks because vaccines can prevent serious illness and disease in individuals, vaccinations can also prevent widespread outbreaks of diseases in populations and the side effect of vaccinations, though occasionally serious, are very rare.

In 1912, measles became a nationally notifiable disease in the United States, requiring U.S. healthcare providers and laboratories to report all diagnosed cases (Measles History, 2014). In the first decade of reporting, an average of 6,000 measles-related deaths were reported each year (Measles History, 2014). In the decade before 1963 when a vaccine became available, nearly all children got measles by the time they were 15 years of age (Measles History, 2014). It is estimated 3 to 4 million people in the United States were infected each year. Also each year an estimated 400 to 500 people died, 48,000 were hospitalized, and 4,000 suffered encephalitis (swelling of the brain) from measles (Measles History, 2014).

In 1954, John F. Enders and Dr. Thomas C. Peebles collected blood samples from several ill students during a measles outbreak in Boston, Massachusetts (Measles History, 2014). They wanted to isolate the measles virus in the student’s blood and create a measles vaccine. They succeeded in isolating measles in 13-year-old David Edmonston’s blood (Measles History, 2014). In 1963, John Enders and colleagues transformed their Edmonston-B strain of measles virus into a vaccine and licensed it in the United States (Measles History, 2014). In 1968, an improved and even weaker measles vaccine, developed by Maurice Hilleman and colleagues, began to be distributed (Measles History, 2014). This vaccine, called the Edmonston-Enders (formerly “Moraten”) strain has been the only measles vaccine used in the United States since 1968 (Measles History, 2014).

The MMR shot protects your child from measles, a potentially serious disease (and also protects against mumps and rubella), prevents your child from getting an uncomfortable rash and high fever from measles, keeps your child from missing school or childcare and keeps you from missing work to care for your sick child (Vaccine and Immunizations, 2015). The measles, mumps, and rubella vaccine is recommended for children 12 months to 12 years old (MMR, 2013). Children should receive the first dose of mumps-containing vaccine at 12-15 months and the second dose at 4-6 years (Mumps Vaccination, 2012). All adults born during or after 1957 should have documentation of one dose (Mumps Vaccination, 2012). Adults at higher risk, such as university students, health care personnel, and international travelers, and persons with potential mumps outbreak exposure should have documentation of two doses of mumps vaccine or other proof of immunity to mumps (Mumps Vaccination, 2012). Pregnant women and persons with an impaired immune system should not receive the MMR vaccine (Mumps Vaccination, 2012). It is a single shot, often given at the same doctor visit as the varicella or chickenpox vaccine (MMR, 2013). Measles can be dangerous, especially for babies and young children (Vaccine and Immunizations, 2015). For some children, measles can lead to pneumonia, lifelong brain damage, deafness and death (Vaccine and Immunizations, 2015).

Measles is a respiratory disease caused by a virus. The virus lives in the mucus in the nose and throat of an infected person (Measles, n.d). Measles remains a common disease in many countries throughout the world, including some developed countries in Europe and Asia (Measles, n.d). While the disease is almost gone from the United States, measles still kills nearly 200,000 people each year globally (Measles, n.d). However, children younger than 5 years of age and adults older than 20 years of age are more likely to suffer from measles complications (Measles, n.d). Measles virus causes rash, cough, runny nose, eye irritation, and fever (MMR Vaccine (Measles, Mumps, Rubella), 2015). It can lead to ear infection, pneumonia, seizures (jerking and staring), brain damage, and death (MMR Vaccine (Measles, Mumps, Rubella), 2015). Pregnant women can give birth prematurely or have a low-birth-weight baby (Measles, n.d).

Mumps is a contagious disease that is caused by the mumps virus. The mumps virus affects the saliva glands, located between the ear and jaw, and may cause puffy cheeks and swollen glands (MMR, 2013). Mumps virus causes fever, headache, muscle pain, loss of appetite, and swollen glands (MMR, 2013). It can lead to deafness, meningitis (infection of the brain and spinal cord covering), painful swelling of the testicles or ovaries, and rarely sterility (MMR, 2013). Most people who have mumps will be protected (immune) from getting mumps again (Mumps Vaccine, 2006). There is a small percent of people though, who could get infected again with mumps and have a milder illness (Mumps Vaccine, 2006).

Rubella, also known as German measles or three day measles is an infectious viral disease, but don’t confuse rubella with measles, which is sometimes called rubeola (MMR, 2013). The two illnesses share similar features, including a characteristic red rash, but they are caused by different viruses (MMR, 2013). Rubella virus lives in the mucus in the nose and throat of infected persons (MMR, 2013). Rubella is usually spread to others through sneezing or coughing. In young children, rubella is usually mild, with few symptoms. They may have a mild rash, whichusually starts on the face and then spreads to the neck, chest, arms, and legs, and it lasts for about three days (MMR, 2013). A child with rubella might also have a slight fever or other symptoms like a cold. Adults are more likely to experience headache, pink eye, and general discomfort one to five days before the rash appears (MMR, 2013). Adults also tend to have more complications, including sore, swollen joints, and, less commonly, arthritis, especially in women (MMR, 2013). A brain infection called encephalitis is a rare, but serious, complication affecting adults with rubella (MMR, 2013). However, the most serious consequence from rubella infection is the harm it can cause to a pregnant woman’s unborn baby (MMR, 2013).

Measles spreads when a person infected with the measles virus breathes, coughs, or sneezes (Vaccine and Immunizations, 2015). It is very contagious. A person can catch measles just by being in a room where a person with measles has been, up to 2 hours after that person is gone, and you can catch measles from an infected person even before they have a measles rash (Vaccine and Immunizations, 2015). Almost everyone who has not had the MMR shot will get measles if they are exposed to the measles virus (Vaccine and Immunizations, 2015). Measles, mumps, and rubella (MMR) vaccine can protect children and adult from all three of these diseases. Thanks to successful vaccination programs these diseases are much less common in the U.S. than they used to be, but if we stopped vaccinating they would return (MMR, 2013).

Between 2000 and 2007, the number of measles cases reached a record low, with only 37 cases being reported in 2004 (Medical News Today, 2015). Last year saw the highest number of reported measles cases in the US since the virus had been declared eliminated (Medical News Today, 2015). There were 23 measles outbreaks in 2014 causing 644 people to become infected (Medical News Today, 2015). According to the CDC, the majority of these cases were brought into the country by travelers from the Philippines (Medical News Today, 2015). Where a large outbreak of the virus was occurring at the time and most of the people who became infected in the US were part of unvaccinated Amish communities in Ohio, but while last year’s statistics seem bad, this years are set to be even worse (Medical News Today, 2015). Last month alone saw 102 measles cases reported over 14 US states, including California, Texas and Washington (Medical News Today, 2015). The majority of these cases are thought to have stemmed from Disneyland, CA, where a number of people reported developing the virus after visiting the amusement part in mid-December (Medical News Today, 2015).

If you don’t have insurance or if your insurance does not cover vaccines for your child, the Vaccines for Children Program may be able to help (CDC, 2015). The Vaccines for Children (VFC) program provides vaccines for children who are uninsured, Medicaid-eligible, or American Indian/Alaska Native (CDC, 2015). No federal vaccination laws exist, but all 50 states require certain vaccinations for children entering public schools (State Laws: Vaccines and Requirements, 2014). Vaccination coverage in America has been historically high as a result of school requirements, caregiver intervention with vulnerable populations, and seasonal influenza-shot drives, but it still falls short (MMR, 2013).

Physicians or other providers must provide the current Vaccine Information Statement (VIS) each time they administer a vaccine covered under the National Vaccine Injury or purchased through the Centers for Disease Control and Prevention grant (Kimmel & Wolfe, 2005). They must record in each patient’s medical record the date of administration, the vaccine manufacturer, the lot number, and the name and business address of the provider, along with the edition of the VIS that was given and the date on which the vaccine was administered (Kimmel & Wolfe, 2005).

An effective interaction can address the concerns of vaccine supportive parents and motivate a hesitant parent towards vaccine acceptance (Leask, Kinnersley, Jackson, Cheater, Bedford & Rowles, 2012). Conversely, poor communication can contribute to rejection of vaccinations or dissatisfaction with care and health professionals have a central role in maintaining education (Leask et al., 2012). These concerns will likely increase as vaccination schedules inevitably become more complex, and parents have increased access to varied information through the internet and social media (Leask et al., 2012). In recognition of the need to support health professionals in this challenging communication task conducted in usually public trust in vaccination; this includes addressing parents’ vaccine concerns (Leask et al., 2012).

There are several reasons why parents are choosing not to vaccinate their children. Parents who decided not to give their child MMR were concerned that the vaccine might cause a reaction in their child (Immunizations, n.d). Most children who have the MMR vaccine do not have any problems with it, or if reactions do occur they are usually mild (Immunizations, n.d). Parents were concerned that the long-term effects of the combined MMR vaccine were not known (Immunizations, n.d). Other reasons given for deciding not to go ahead with MMR were concern about the ingredients of the vaccines and that live vaccines were used and that these would be too much for a child’s body to cope with (Immunizations, n.d). A very small number of parents personally believed that immunity derived from actually having the disease was more effective than the immunity obtained from vaccines (Immunizations, n.d).

There is no scientific evidence that MMR vaccine causes autism. The suggestion that MMR vaccine might lead to autism had its origins in research by Andrew Wakefield, a gastroenterologist, in the United Kingdom (DPH, 2013). In 1998, Wakefield and colleagues published an article in The Lancet claiming that the measles vaccine virus in MMR caused inflammatory bowel disease, allowing harmful proteins to enter the bloodstream and damage the brain (DPH, 2013). The validity of this finding was later called into question when it could not be reproduced by oth­er researchers (DPH, 2013). In addition, the findings were further discredited when an investigation found that Wakefield did not disclose he was being funded for his research by lawyers seeking evidence to use against vaccine manufacturers (DPH, 2013). Wakefield was permanently barred from practicing medicine in the United Kingdom (DPH, 2013).

There will always be some cases of measles in the US, as it can still be brought into the country by individuals from other countries who have not been vaccinated. The CDC says the MMR vaccine is safe, and one dose of the vaccine is around 93% effective at preventing measles, while two doses is approximately 97% effective (Medical News Today, 2015). Immunization is the only effective way of protection for children against these diseases because children’s immune systems are defenseless against them because they are not fully developed yet, and once infected in most cases there is no cure or at least a very low chance of one.

References

Center for Disease Control (2015, February 5). Retrieved March 18, 2015, from http://www.cdc.gov/vaccines/vpd-vac/measles/fs-parents.html

DPH: Infectious Diseases. (n.d.). Retrieved March 22, 2015 http://www.ct.gov/dph/cwp/view.asp?a=3136&q=397352

Immunization. (n.d.). Retrieved March 18, 2015, from http://www.healthtalk.org/peoples-experiences/pregnancy-children/immunisation/deciding-not-give-my-child-mmr-measles-mumps-and-rubella

Kimmel, S. R., & Wolfe, R. M. (2005). Communicating the benefits and risks of vaccines. The Journal of Family Practice, 54(1 Suppl), S51-S57

State Vaccines and requirements. (2014, December 12). Retrieved March 22, 2015, from http://www.cdc.gov/vaccines/imz-managers/laws/state-reqs.html

Leask, J., Kinnersley, P., Jackson, C., Cheater, F., Bedford, H., & Rowles, G. (2012). Communication with parents about vaccination: a framework for health professionals. BMC Pediatrics, 12154. doi:10.1186/1471-2431-12-154

Measles History. (2014, November 3). Retrieved March 18, 2015, from http://www.cdc.gov/measles/about/history.html

Medical News Today (2015, February 5). Retrieved March 18, 2015, from http://www.medicalnewstoday.com/articles/289060.php

MMR (Measles, Mumps, & Rubella) Vaccine. (2013, June 18). Retrieved March 18, 2015, from http://www.cdc.gov/vaccines/hcp/vis/vis-statements/mmr.html

MMR Vaccine Does Not Cause Autism Examine the Evidence! Retrieved March 19, 2015, from http://www.immunize.org/catg.d/p4026.pdf

Mumps Vaccine. (2006, October 16). Retrieved March 22, 2015, from http://www.cdc.gov/vaccines/vpd-vac/mumps/vac-faqs.htm

Mumps Vaccination. (2012, July 2). Retrieved March 22, 2015, from http://www.cdc.gov/mumps/vaccination.html

Vaccine and Immunizations. (2015, February 5). Retrieved March 22, 2015, from http://www.cdc.gov/vaccines/vpd-vac/measles/fs-parents.html

Measles. (n.d.). Retrieved March 22, 2015, from http://www.vaccines.gov/diseases/measles/index.html

MMR Vaccine (Measles, Mumps, and Rubella): MedlinePlus Drug Information. (n.d.). Retrieved March 22, 2015, from http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601176.html