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Immmunization

Divya Narala

Vaccinate on Time to Prevent Epidemics of Contagious Diseases- MMR

Convincing caregivers that vaccinating children with appropriate vaccine doses to prevent outbreaks of preventable diseases such as the MMR (measles, mumps and rubella) outweighs the side effects they may cause. As of May 8, 2017, in Minnesota, there were 48 confirmed cases of measles and 45 of them had not been vaccinated.2 According to the CDC, the side effects range from mild to severe, and the severe side effects are extremely rare that it is not possible to say if the vaccine has caused it. For example, 1 out of 3,000 doses cause seizures, 1 out of 30,000 doses cause bleeding disorders, and the more serious effects occur in 1 out of a million.20 Vaccinated children are protected only if all 3 doses are taken in a timely manner opposed to only 1 or 2 doses. According to Dr. Luman et al., the measles epidemic during 1989 to 1991 was due to missing doses.7 Preventing such outbreaks is important among children more so than adults because their immune system is not fully developed. When a child gets either of the MMR diseases, the effects are more detrimental, hence why the Advisory Committee on Immunization Practices should implement stricter regulations. The Advisory Committee on Immunization Practices and the Department of Education need to work together to reinforce the importance of vaccinations in children so that “20 million illnesses” are stopped, “40 thousand deaths” are prevented and “70 billion dollars” are saved.”4,13

Measles can cause “fever, cough, runny nose, red, watery eyes,” diarrhea, pneumonia and brain damage.20 Mumps causes “fever, headache, muscle aches, tiredness, loss of appetite,” swollen glands (salivary), swelling of ovaries and testes, deafness, and meningitis.20 Rubella as well causes “fever, sore throat, rash, headache, red, watery eyes,” and pregnant women have miscarriages.20 With any of the 3 diseases there is an increased risk of death that could have been prevented if majority of the population was vaccinated. Now, the side effects…According to a study done in Finland, the once thought high number of side effects is not true for the MMR vaccine.16 Table 1 lays out the number of children with side effects in both the placebo and vaccine group among 686 pairs of twins. On top of that, the placebo group had a higher rate of respiratory issues than in the vaccinated group.16 

Importance of timeliness of vaccines

The measles epidemic during 1989-1991 in the USA was failure to vaccinate at appropriate intervals.6 According to Kroger et al., “only a sustained effort to provide age-appropriate vaccination will prevent another resurgence of measles”.14 As mentioned prior, missing a dose not only prevents full immunity but can lead to the disease itself, hence following the recommended guidelines regarding the interval between the doses is important. Figure 1 specifies the timelines for various vaccinations and when they should be given to be most effective. Also, not following the schedule may require one to redo the whole series of the vaccination.18 Lastly, Dr. Hambidge mentions that the rate of seizures increases in children whose vaccinations are delayed.11,12

The Problem

Some reasons children had delayed or missed doses are due to the following reasons: “a mother who was unmarried or who did not have a college degree, living in a household with 2 or more children, being non-Hispanic black, having 2 or more vaccination providers, and using public vaccination providers”.7 Other reasons are access to the vaccine/healthcare in general, whether it be distance or education, beliefs, fear of the minor side effects, or other priorities.8 In addition, if physicians are not well educated, they may not be able to explain to the parents that vaccines are a number one public health achievement.21 Children may miss school due to being sick with either prodromal symptoms or full blown disease.21 (Prodromal symptoms are those in which come prior to the disease or early minor symptoms.15)

Conclusion

One organization that provides vaccinations for rural communities includes the Global Alliance for Vaccines and Immunizations (GAVI). GAVI’s mission is to allow coverage of vaccines for free in poor countries.10 The aim for GAVI is to vaccinate 300 million children by the year 2020, thus preventing 5-6 million deaths.10 Furthermore, having a tracking system of some sort can help parents, physicians and school staff to be up to date on the series of the children’s vaccinations.1 This tracking system is in place in Britain1 and seems to be working thus far, hence I feel if the US used it, many children would be vaccinated on time. According to Desai and Alva, “the link between maternal education and child immunization status remains fairly strong”.5 In addition to properly educating the child and parents, it is important for healthcare providers, as well, to be educated. Dr. Peter mentions that many times, healthcare providers hesitate to double up on vaccinations during a well visit in fear of adverse reactions, however that is not the case.17 These implementations of these recommendations regarding vaccinations will prevent outbreaks not only of MMR, but perhaps other contagious diseases as well. Spacing of vaccinations according to the specified guidelines is extremely important. As Dr. Smith summarized the situation, “You never know when you’re going to get hit. And if you delay or space out your child’s shots, not only are you putting your kids at risk, but you’re putting other people’s kids at risk too”.12

References:

  1. Bodenheimer, T., & Grumbach, K. (2012). Understanding health policy: A clinical approach. New York: McGraw-Hill Medical.

  2. Branswell, H. (2017, May 08). Measles sweeps an immigrant community targeted by anti-vaccine activists. Retrieved December 12, 2017, from https://www.statnews.com/2017/05/08/measles-vaccines-somali/

  3. Brieger, D., Edwards, M., Mudgil, P., & Whitehall, J. (2017). Knowledge, attitudes and opinions towards measles and the MMR vaccine across two NSW cohorts. Australian & New Zealand Journal Of Public Health, 41(6), 641-646. doi:10.1111/1753-6405.12720

  4. Dempsey AF, Zimet GD. Interventions to improve adolescent vaccination: what may work and what still needs to be tested. Vaccine. 2015;33(suppl 4):D106–D113. 

  5. Desai, S., & Alva, S. (1998). Maternal Education and Child Health: Is There a Strong Causal Relationship? Demography, 35(1), 71-81. Retrieved from http://www.jstor.org/stable/3004028

  6. Donald A. Henderson, Frances J. Dunston, David S. Fedson, Vincent A. Fulginiti, Robert John Gerety, Fernando A. Guerra, Kay Johnson, Edgar K. Marcuse, Don P. Metzgar, Ronald J. Saldarini, Parker A. Small, Gene H. Stollerman, Thomas M. Vernon, Catherine Wilfert. The Measles Epidemic: The Problems, Barriers, and Recommendations. JAMA. 1991;266(11):1547–1552. doi:10.1001/jama.1991.03470110093039

  7. Elizabeth T. Luman, Lawrence E. Barker, Kate M. Shaw, Mary Mason McCauley, James W. Buehler, Larry K. Pickering. Timeliness of Childhood Vaccinations in the United StatesDays Undervaccinated and Number of Vaccines Delayed. JAMA. 2005;293(10):1204–1211. doi:10.1001/jama.293.10.1204

  8. Favin, M., Steinglass, R., Fields, R., Banerjee, K., & Sawhney, M. (2012). Why children are not vaccinated: a review of the grey literature. International Health, 4(4), 229-238. doi:10.1016/j.inhe.2012.07.004

  9. Gardner, A. (2015). Is There an Alternative Vaccine Schedule? Retrieved December 12, 2017, from https://www.webmd.com/children/vaccines/features/alternative-vaccine-schedule#2

  10. http://www.gavi.org/about/mission/

  11. Hambidge, Simon J., et al. AAP News and Journals Gateway, 2014, pediatrics.aappublications.org/content/early/2014/05/14/peds.2013-3429.

  12. Heid, M. (2014, July 16). Should You Follow Vaccine Guidelines. Retrieved December 03, 2017, from http://time.com/2992222/spacing-out-kids-vaccines-can-hurt-their-health/

  13. Khabbaz RF, Moseley RR, Steiner RJ, et al. Challenges of infectious diseases in the U.S.A. Lancet. 2014;384(9937):53–63.

  14. Kroger, A. T., MD, Atkinson, W. L., MD, Marcuse, E. K., MD, & Pickering, L. K., MD. (2006). General Recommendations on Immunization Recommendations of the Advisory Committee on Immunization Practices (ACIP). Retrieved December 02, 2017, from https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5515a1.htm

  15. https://medical-dictionary.thefreedictionary.com/Prodromal+symptoms

  16. Peltola, H., & Heinonen, O. (1986). Frequency Of True Adverse Reactions To Measles-Mumps-Rubella Vaccine. The Lancet, 327(8487), 939-942. doi:10.1016/s0140-6736(86)91044-5

  17. Peter, G. (1992). Childhood Immunizations (J. F. Desforges, Ed.). New England Journal of Medicine, 327(25), 1794-1800. doi:10.1056/nejm199212173272507

  18. Tetreault, L., MD. (2015, August 26). The Importance of Being on Time: Why the Vaccine Schedule Benefits Young Children. Retrieved December 03, 2017, from http://www.vaxmainekids.org/the-importance-of-being-on-time-why-the-vaccine-schedule-benefits-young-children/

  19. Vaccines and Preventable Diseases. (2016, November 22). Retrieved December 01, 2017, from https://www.cdc.gov/vaccines/vpd/mmr/public/index.html

  20. Vaccine Safety. (2017, May 04). Retrieved December 01, 2017, from https://www.cdc.gov/vaccinesafety/vaccines/mmr-vaccine.html

  21. CDC Features. (2017, July 31). Retrieved December 12, 2017, from https://www.cdc.gov/features/reasonstovaccinate/index.html