Fighting Back

By Richard Trubo
WebMD Feature

Reviewed By Charlotte Grayson

When Mary-Clayton Enderlein was in her ninth month of pregnancy with her second baby, there wasn't a hint that anything might go awry as she approached her due date. But when the family of one of her first child's playmates paid a visit, Mary-Clayton noticed that some of them were having coughing spasms with a whooping sound.

"I'm a registered nurse," says Mary-Clayton. "So I was familiar with the unique sound of their cough. I thought they had pertussis."

Pertussis, or whooping cough, is a highly contagious bacterial disease that causes severe coughing and gasping for breath. Mary-Clayton's son had been immunized with the DTP (diphtheria-tetanus-pertussis) vaccine, but his friend's family hadn't. And because Mary-Clayton's own pertussis vaccine dated back to childhood, her own protection was wearing thin.

"Seven days after I had been exposed, I began coughing," recalls Mary-Clayton. While she was waiting for the test results to determine if she had, in fact, contracted whooping cough, her water broke and she went into labor.

Mary-Clayton delivered a healthy baby boy. "But in my first kiss," she says, "I gave him pertussis."

A week later, her new son, Colin, began have coughing spasms, 50 to 70 coughs at a time. As he vomited and turned blue, Mary-Clayton and her husband rushed him to the emergency room, and he was admitted to the hospital.

Colin's whooping cough was treated with antibiotics, and although he returned home (with monitoring devices) after a few days, he didn't fully regain his strength for months.

"I've always felt that immunizations are our social responsibility," says Mary-Clayton. "Vaccinating children is part of the social contract that we have with the communities we live in."

A Healthy Shot in the Arm

More than most people, Mary-Clayton knows the risks of non-vaccination. Although immunization rates are very high in the U.S., they have declined slightly in recent years. "About 1.8% of children are not receiving vaccines because their parents have refused to immunize them," says Sharon Humiston, MD, MPH, a pediatrician at the University of Rochester Medical Center in New York.

That's an increase from a recent 0.8% refusal rate, she adds. "But many other children are not receiving their vaccines because parents don't realize that their child's shots are not up-to-date."

The decline in vaccination rates, although small statistically, is worrisome to some experts, who are keeping a watchful eye on whether a trend might be developing. At the same time, many doctors and some parents like Mary-Clayton are concerned that unvaccinated classmates of their own children may be posing unnecessary health risks to everyone they encounter, possibly leading to increasing numbers of youngsters (and adults) who contract these preventable infections.

"Some diseases are smoldering below the surface, like the measles, mumps and German measles," says pediatrician Paul Offit, MD, director of the Vaccine Education Center at The Children's Hospital of Philadelphia. "These diseases occur in the hundreds of cases per year. If immunization rates decline, they'll be back."

Certain other vaccine-preventable diseases already occur more frequently than those mentioned above. "Varicella [chickenpox] infections, pneumococcal bacterial [a type of pneumonia] infections, and pertussis [whooping cough] infections are still common enough that when a choice is made not to get vaccinated, this is often a choice to get the diseases," adds Offit.

Just Saying "No"

Immunization proponents believe that vaccines may be a victim of their own success. "These vaccines prevent more diseases than any other health intervention," says Gary Freed, MD, MPH, director of general pediatrics at the University of Michigan Health System. Yet because immunizations have proven so effective, most parents don't remember a time when polio paralyzed 10,000 children a year in the U.S., or whooping cough killed 8,000 youngsters annually.

"That's why the 'vaccination hesitant' movement is so successful, because no one remembers what it was like before immunizations, and the true health threat that is posed when kids aren't immunized," says Christine Kukka, communications director of Parents of Kids with Infectious Diseases (PKIDs), a Vancouver, Washington-based national organization that encourages childhood vaccinations, and was founded by parents whose youngsters had developed infectious diseases.

Yet some parents are convinced that immunizations are just too risky, particularly at a time when many vaccine-preventable diseases like polio and diphtheria have been virtually wiped out in the U.S. They worry whether a youngster's small body can handle the growing number of shots - as many as 20 of them - that are now recommended for children by the age of two years. On the Internet, there are many high-profile anti-immunization sites, most started by activist parents, which challenge the safety of the commonly recommended shots, and have fueled anxiety among many mothers and fathers.

In a study published in the Journal of the American Medical Association in June 2002, researchers at the Northwestern University Feinberg School of Medicine in Chicago concluded that anti-vaccination Internet sites rely more on emotional appeals than solid scientific evidence in warning parents that vaccines may cause everything from autism to hyperactivity to diabetes to sudden infant death syndrome (SIDS).

Nevertheless, even some doctors appear hesitant to support universal vaccinations. A 2001 study by Freed found that 21% of family physicians and 12% of pediatricians occasionally or routinely refrained from recommending particular vaccines to some or all of their patients. Even so, while no vaccine is risk-free - sometimes causing side effects such as a sore arm, a mild fever or, very rarely, severe allergic reactions - most doctors concur that the benefits of vaccinations far outweigh any dangers.

Who's At Risk?

Forty-eight of the 50 states permit exemptions from mandatory childhood vaccinations for religious reasons, while 15 states permit philosophical exemptions. All allow exemptions based on medical grounds.

But when parents decide not to vaccinate their children, they may be placing even some immunized youngsters at risk for contracting the infections, such as children whose vaccinations have not provided them with full immunity.

"Like other medications, vaccines are not 100% effective," says Humiston, author of Vaccinating Your Child: Questions and Answers for the Concerned Parent. "With the chickenpox vaccine, about 90% of children are protected after receiving one dose. But that means that for every 1,000 kids, 100 aren't protected, although they may have only a mild case if they get the disease." These children may become ill when exposed to an unvaccinated playmate who has developed the chickenpox.

Youngsters with impaired immune systems -- including those chronically taking corticosteroids because of severe asthma, or kids who are HIV-positive or who have cancer -- cannot receive the vaccines at all, and thus they may susceptible to germs from infected, nonimmunized children.

"If the proportion of the vaccinated population drops significantly, there will be epidemics of particular diseases to which all susceptible children will be exposed," cautions Freed.

Offit agrees, noting that "if someone near you chooses not to vaccinate, they're clearly at increased risk, and therefore that increases your risk."

As more parents understand this phenomenon, it has raised their own anxiety levels. "There are definitely parents who don't like it if their vaccinated child is in a classroom with one or more children who are not vaccinated," says Offit. "They sense that this puts their child at risk, and their sense is correct."

Reliable Sources

If you're unsure about the safety or advisability of vaccinating your children, Humiston advises taking your concerns to your own pediatrician. "Have your questions ready when you visit the doctor's office," she says. "Also, pick a pediatrician who you feel keeps up with medical issues."

"All you need to do is sit in a parent's shoes for a day to see what it's like to have a child who has been harmed or killed by a disease, or who faces a chronic lifelong infection," says Kukka. "It's a quick and grim reminder of how valuable vaccines are."

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