Daniel A. Hagerman, M.D., is chair, section on pediatrics, at Columbia Center and associate clinical professor at the Medical College of Wisconsin’s pediatrics department. He will be moderating and speaking at “Children & Vaccines: Addressing Parents’ Concerns,” an educational event hosted by Columbia Center, on October 22, at 6:30 pm.
Q. What is the most important message you want to give to parents about vaccinations for children and for themselves?
Vaccination is one of the greatest success stories of modern medicine. Diseases that are now vaccine preventable used to cause widespread disease and countless deaths. The good news is that many of today’s parents have not had personal experience with these diseases. But they may question the benefit of vaccinating their children, especially when they see vaccines presented in a negative light in the media and Internet. The reality is that vaccines are among the most rigorously studied medications we have. They have a remarkable track record of safety and effectiveness. The most important point that I’d like to make is: Vaccines do NOT cause autism. The science is crystal clear.
Q. Could you briefly explain the concept of herd immunity?
Herd immunity means that if enough individuals in a community are immune to a disease, the disease cannot successfully propagate itself. Herd immunity is an important concept in vaccination. Not only do we protect ourselves and our children by being vaccinated, we also protect one another – including those who, for a variety of reasons, are vulnerable or can’t be vaccinated. We must not, however, become complacent and skip vaccinations thinking that herd immunity will protect us or our children. Major disease outbreaks are “one person on a plane” away from happening. One person’s decision not to vaccinate their child can devastate the lives of many others.
Q. What are the best ways to prevent H1N1?
Vaccination is the best way to prevent the 2009 H1N1 influenza infection. Frequent hand washing is the next best preventive measure. Cough into your upper sleeve or elbow instead of your hands. Avoid touching your face, nose, and eyes – that’s how the virus is spread. Parents should keep their kids home from school when they are sick. Kids may return to school once they start to feel better and their fever has been gone for 24 hours without fever-reducing medicines (Tylenol or Ibuprofen).
Q. How serious is H1N1 shaping up to be in the greater Milwaukee area this season? What are the most common symptoms?
The 2009 H1N1 virus is a concern for two reasons. First, since no one under 60-65 years of age has natural immunity to this virus, large numbers of people could be infected. Some estimates suggest that 40–50% of all Americans could be infected. Second, while most of the time the H1N1 virus has caused relatively mild disease, there have been a disproportionate number of children who have gotten critically ill and died.
The common symptoms of the 2009 H1N1 influenza virus are largely the same as typical seasonal influenza: sudden onset of illness, cough, fever, body aches, weakness/fatigue, headache, and sore throat. Some people also develop vomiting and diarrhea. The worry signs for a more serious infection are difficulty breathing, pale or bluish discoloration of the skin, coughing up blood, dehydration, or confusion.
Q. I watched a news show recently where one doctor said he wouldn't give the H1N1 vaccine to his children because he considered H1N1 less dangerous than the common flu and he wasn't confident in the vaccine’s safety. Obviously his opinion is in the minority, but it makes me wonder: how confident can parents be in this vaccine? How confident are you in it?
People are concerned because this vaccine is new. Remember though, that each year’s “flu” vaccine is new. This vaccine is made in the same manner as any other influenza vaccine. It is produced by the same companies in the exact same way. Additional concern originates from the experience with the “swine flu” vaccine from 1976. About 1 in 100,000 people who got this vaccine developed Guillain-Barre syndrome, a form of paralysis. This was especially troubling because that year, the “swine flu” never materialized as a major disease. With today’s influenza vaccine technology, the risk of Guillain-Barre syndrome is less than 1 per 1,000,000. More importantly, the 2009 H1N1 virus is already here as a significant cause of illness and hundreds of deaths. Lastly, some people are reluctant to vaccinate because they think that this isn’t a serious disease. Clearly, the occurrence of 70 deaths among children in the U.S. from this disease already speaks to the contrary.
Q. Some moms on the MilwaukeeMoms discussion board are concerned because they can’t get flu shots for their children until at least November. What should parents do if they’re unable to get in to their doctor quickly to get their children the shots they want?
The federal government ordered and expects 195 million doses of the 2009 H1N1 vaccine. The very first small shipments of vaccine have already been made. Unfortunately, the vaccine will be available in 20 million dose increments every one to two weeks. In the end, there should be plenty of vaccine, but it may take a bit longer to get everyone vaccinated than we would like. On the other hand, since this virus just appeared six months ago, getting this vaccine produced so quickly has been a tremendous success
Q. What do you think about the idea of delaying and/or separating vaccines, which some parents do, instead of following a traditional vaccination schedule?
The most important thing to know about this concept is that it has absolutely no scientific basis. It derives from fear of vaccines and about their role in autism. Once again, the science is clear: vaccines do NOT cause autism. We have an enormous body of evidence showing that vaccines are safe when given in the currently recommended schedule. The safety and effectiveness of delaying or separating vaccines is completely unknown.
Vaccines are given to infants and young children early to protect them from diseases when they are at their most vulnerable. Delaying vaccines delays their protection. What about separating them? Since we know that the MMR [measles, mumps and rubella] vaccine does not cause autism and we have 40 years of safety data with the MMR vaccine, there is no rational reason to separate them. Separating vaccines leads to more visits to the doctor for shots, more risk of mistakes or adverse events from vaccine administration, and significantly increased cost while leaving kids vulnerable to the diseases longer.
The anti-vaccine movement suggests that we are presenting too many antigens (proteins) in vaccines and that infants’ immature immune systems can’t handle them. This represents a major misunderstanding of the capabilities of our immune systems. The number of antigens in vaccines is insignificant relative to the number of antigens to which we are exposed on a daily basis. Additionally, in spite of the current vaccine schedule protecting against many more diseases, the total number of antigens has dropped dramatically in the past 30 years.
Q. Do you think Wisconsin is too lenient with its vaccine laws (i.e. allowing parents to opt out of vaccinating for health, religious and/or personal reasons)? Why/why not?
My personal opinion is “no.” While I am whole-heartedly in favor of vaccines, I don’t think the government should be in the business of coercing its citizens. I wouldn’t want to see children blocked from attending school because their parents made an ill-informed decision.
Q. Have vaccines been tested sufficiently in pregnant mothers to guarantee safety? If there is any vaccine risk to the mom or unborn baby, how does it compare to the risk of getting sick?
The seasonal and 2009 H1N1 influenza vaccines are clearly safe for pregnant and nursing women. However, they should not get the intra-nasal, live-attenuated vaccine (“Flumist”). In fact, pregnant women should never get live vaccines. All vaccination decisions during pregnancy should be made in consultation with your obstetrician. New mothers should consider getting the Tdap vaccine to help protect their newborn from Pertussis.
Q. What question haven't I asked that you think would be important for parents to know the answer to? Please also give the answer.
Do vaccines cause autism? NO!
