Since I began practicing pediatrics in this community more than 30 years ago, I have seen the introduction of new technology, procedures, medications and specialty services for children. While all these improvements have made a difference in improving child health, none of these trends compares in importance to the benefits of the vaccines that have emerged over those decades.

In 1982, the immunization schedule was pretty simple. DPT shots (diphtheria-pertussis-tetanus) were given, along with an oral polio vaccine, three times during the first year, once at 18 months, and again prior to kindergarten. The MMR shot (measles-mumps-rubella) was given at 15 months.

The entire cost, from birth to school age, was about $40. We rarely gave more than one injection at a time at a single visit.

When the HIB (Hemophilus Influenza Type B) vaccine came out in the mid-1980s, we had to start poking an infant twice at a visit, though this was a bit shocking at first. H-Flu, however, was one of the scourges of childhood at that time, leading to large numbers of hospitalizations with life-threatening illnesses, including meningitis and airway obstruction. Unfortunately, death and neurological damage were regular outcomes.

We were more than happy to trade the stress of giving two shots to cut down the rate of that illness. Indeed, after the current vaccine came on board in 1987, H-Flu disappeared. A similar vaccine for another childhood illness — pneumococcal disease — was developed in the 1990s, further reducing the frequency of serious illness.

My hesitation at giving more than one shot per visit in the 1980s was based on my reluctance to cause discomfort, however brief. Over the years, I have gotten used to it, because of what I see as the huge benefit these vaccines provide to the children in my care.

Scientists have studied the effects of giving multiple vaccines at once and have established that “immunologic overload” does not occur. We are built to withstand thousands of invading organisms all at once.

The data on vaccine safety are overwhelming. In my 40 years of medical practice, I have not seen any long-term harm from a vaccine. Nasty side effects, such as high fever or even febrile seizures (fewer than 1 case per 2,000), however, can occur. Sore legs and arms and low-grade fevers are common, but even those rates have gone way down with the newer products.

Vaccines have become victims of their success. We rarely see these preventable diseases anymore, so parental concern has shifted to the perceived risks of the vaccines, since they don’t have any experience with the illnesses that are prevented. As long as most persons are immunized, “herd immunity” provides some protection to the unimmunized. The debate raised by the current measles outbreak has led to deserved criticism of people who have chosen that path, since their numbers put the rest of the population at increased risk. As we have learned, those diseases are only an airplane ride away.

From a public health point of view, vaccinations should be compulsory. From a civil liberties point of view, however, the issue gets more complicated. We are a free country. People have the right to make their own decisions about health care, including such things as smoking, wearing bike helmets, the size of their sugary soft drink, etc. But we don’t allow people to speed on the highways, since this puts others at risk.

Responsible parents, who don’t want their children to be at increased risk from unvaccinated children, are now starting to take a stand against those parents whom I would label as irresponsible.

Unimmunized children are allowed in Maine schools. The vaccine rejecters need to fill out a form stating only that they have philosophical objections based on personal beliefs. Proposed legislation doesn’t do much to halt this behavior; it just compels these families to have a serious discussion with their medical caregiver about the risks and benefits of vaccines, and get a second form signed. Part of the discussion involves learning about school exclusion policies for the under-immunized, which kick in when cases of preventable illnesses show up in the school or town.

This is the least we can do to balance the rights of responsible parents — who want their children educated in a safe environment — with the rights of those parents who mistakenly choose to reject science.

Sydney R. Sewall, MD MPH, practices at Kennebec Pediatrics, Augusta. He also is a member of the Maine Chapter, American Academy of Pediatrics.


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