By Stuart H. Ditchek, MD Board Certified Pediatrician Faculty, NYU School of Medicine
As a follow up to last month’s article (The Reality of Vaccine-Preventable Diseases), I have been asked to continue the discussion regarding the importance of childhood vaccinations and why parents should understand this complex issue. In addition, I will provide a follow up on the current Israel measles outbreak.
Unfortunately, as of the end of August, Israel saw a reported 700 cases of measles over three months resulting in the death of two toddlers to date. The majority of hospitalized seriously sick children are unimmunized. Historically, both Israel and New York have had outbreaks in similar time periods as there is so much travel between the two locations, especially for the New York Jewish community. Unfortunately, with the number of families who have sought out falsified vaccination records recently, we do not currently know how many children in our communities are unimmunized or under immunized. This makes the risk to susceptible individuals much greater.
Why Vaccine Protocols Have Changed
Understanding historical perspectives and how many of the vaccine protocols have developed is an important part of good parenting. Let’s take a few examples of how recommendations evolved as science advances over time. For example, flu vaccines are recommended now for all children over six months, whereas years back it was only recommended to vaccinate the highest risk individuals such as those with heart or respiratory disease. The answer lies in the complication rates over the past 20 plus years and how it has changed.
In 2010, the flu vaccine was added to the annual recommendations for all children. The two factors that changed the recommendations were bacterial secondary complications and the post swine flu lessons of 2009.
Years back, there was minimal bacterial resistance throughout the United States. Over time with the overuse of antibiotics, we have seen a tremendous emergence of MRSA (Methicillin Resistant Staph Aureus). This dangerous aggressive bacteria finds the most susceptible hosts and wreaks havoc on certain patients.
Flu Patients Have Gotten Sicker
The research supports the fact that as MRSA and other bacterial strains became dominant, those sick with flu were getting hospitalized at much higher rates. The majority of flu complications are the result of secondary pneumonias, many with MRSA. This type of complication often leads to hospitalization and serious complications including respiratory failure.
ICU-level care became more common for the unimmunized. Many of the sickest patients suffered terrible outcomes including deaths and amputations as a result of the severe infections. In children, the overwhelming majority of hospitalized children with flu complications are those not immunized. The fact remains that immunized children have a dramatically lower complication rate specifically for hospitalization.
While the flu vaccine is approximately 60 percent effective to prevent getting the flu, it is more than 90 percent effective in preventing hospitalizations in children. The other factor that has evolved and made the seasonal flu much more serious is the effects of the H1N1 swine flu variant.
Swine Flu
The novel swine flu variant appeared in the late spring of 2009. Existing flu vaccines were ineffective against this variant. That year, many pregnant and postpartum women were very sick and hospitalized with swine flu. Babies were being delivered by C-section in the ICUs as the mothers were too critical to risk transport to the operating room.
Why did the new variants cause such serious disease? Firstly, pregnant and postpartum women lose immunity to many infections as a result of a normal pregnancy. The other factor is related to these newer variants effects on the bone marrow causing an inability to fight infections. The current flu variants cause very significant and often unnoticed suppression of the white blood cells originating in the bone marrow. This suppression can lead to the inability to fight off the bacterial complications seen in flu, especially pneumonias.
In other words, this was not your mother’s seasonal flu that mostly affected those at highest risk. Flu vaccination is critical for all children especially the youngest ones. In my practice, flu vaccine compliance has been very good as the result of efforts to educate families. However, since the recent anti-vaccine movement has erupted, this has become more difficult.
RSV Vaccine
Let’s look at the RSV (Respiratory Syncytial Virus) vaccine, which is now a standard recommendation for all babies either after delivery or by the mother receiving it in the third trimester.
RSV is a very dangerous respiratory virus that affects tens of thousands of babies annually, often resulting in hospitalization and sometimes, unfortunately, death. This virus is benign to most healthy older children and adults (with the exception of seniors) but is very serious in newborns.
In the past two years, a recommendation came about to give babies these monoclonal antibodies to prevent complications. Those who object to vaccines would have you believe that this is a brand new vaccine and not studied. That is false. RSV vaccine is a passive antibody administration, much like the monoclonal infusions that saved so many during early COVID. There is no immune response required by the infant. The vaccine simply provides long-acting antibodies to the infection that lasts for a period of months.
This monoclonal antibody is not new. Pediatricians have been giving a product called Synagis to preemies and high risk infants since 1999. Synagis is very similar to the RSV monoclonal product (Beyfortus) except that it is a short acting antibody that requires five doses per season rather than one, as required for Beyfortus. Since the introduction of the RSV monoclonal vaccine, hospitalizations have been dramatically reduced. It is very well tolerated with minimal side effects as the baby is not required to actively mount an immune response. The antibody is given to protect the baby during RSV season in the first year of life and in the second year for higher risk babies. It is very important for parents to understand the critical nature of how this simple passive immunization with monoclonal antibody is saving lives.
Chickenpox Vaccine
One more vaccine innovation that did not exist until the early 1990s is the vaccine for Varicella (chickenpox), initially developed for use in high risk children recovering from cancer or other immunosuppressive treatments.
The recommendations changed in the early 1990s to now give this vaccine to healthy children. This is due to the complication rates from MRSA and other bacterial risks. When I was a child, chickenpox was a rite of passage with minimal bacterial secondary complications. Once antibiotic resistance and MRSA came about in the late 1980s, we started seeing children hospitalized with bacterial sepsis (blood infections), cellulitis (soft tissue infections), and serious complications.
The reason is that a typical child with Varicella has a large number (sometimes in the hundreds) of open wounds that are easy penetration points for bacteria such as MRSA. Once again, this is not your mother’s chickenpox of past years. As a young practitioner, it took me two years to adopt this recommendation as I wanted to see more data before using it broadly with my patients. It was clear that the vaccine led to dramatic hospitalization reduction and the associated complications. Is it as perfect as natural immunity? No. But the benefits far outweigh the risks. Once again, in my private practice, I have not seen a single case of chickenpox since the mid-1990s.
Mercury in Vaccines?
As you can see, understanding disease processes and solutions is critical for parents. I am often asked if vaccines contain thimerosal (ethyl mercury), a preservative. The thimerosal scare is a myth often touted by anti-vaccine activists. In my 35-year history, my practice has never used the only thimerosal containing vaccine, which is the multi-dose flu vial.
These vials are primarily used in countries where storage and shipping of single dose vaccines is difficult, such as third world countries. More importantly, ethyl mercury is excreted easily in all humans and not stored in tissues. Methyl mercury present in carnivorous fish (i.e. tuna) and present in certain environmental exposures is potentially toxic. In the book that I authored in 2001 on integrative pediatrics, Healthy Child Whole Child (Harper Collins Publishers), I advise no fish during pregnancy and limited carnivorous fish for all children and adults in general. Mercury is not an issue in childhood vaccinations in almost all medical practices.
In Conclusion
In closing, be smart and don’t let the politics of vaccination influence your decision process. We have an obligation to protect our own children and all children in our communities. When we allow those who refuse vaccinations into our schools, it puts many at risk. I have many families with children who are in the highest risk categories in schools all over Brooklyn and Manhattan. These are children recovering from cancer, immune disorders who are on immunosuppressive therapies, and others.
They must often wait until their immune systems recover from the effects of their treatments to receive boosters or get re-immunized after their immune system gets washed out by the treatments. That makes them very susceptible. The parents of those children are terrified right now as they are well aware that there are those in the community who have falsified their children’s vaccination status. That is not who we are as a community.
Please listen to your doctor and do the right thing to protect all children.