the vaccine war

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Sigall Bell, M.D.
April 22, 2010 11:02
Sigall Bell M.D.An assistant professor of medicine at Harvard Medical School and a member of the Division of Infectious Diseases, Beth Israel Deaconess Medical Center. She is the director of the BIDMC travel medicine clinic and the mother of two young children.

Asked in a survey whether they thought vaccine decisions should be made by parents or government, focus group participants told political scientist Hank Jenkins-Smith they wanted to make their own decisions. Even those who agreed with vaccines wanted to be in charge. I'm not surprised. When it comes to my kids, I want to vote with my own feet too. And I do that with school choices, TV rules, video games, etc. But when you say "No" to vaccines for you, you are also saying "No," to some degree, for me.

We've long known that children in the same community belong to a shared pool of infection risk. If I pay insurance but you don't, both of our kids are at increased risk. This is because while very protective, vaccines are not 100% effective. Some children may not mount a full immune response after vaccination. Some children can't get vaccinated because they are not old enough or because they have underlying health conditions that preclude safe vaccination. If enough kids lack protective immunity and the illness enters the community, it's not just the unvaccinated child that gets sick. In fact it is often the vulnerable children who couldn't get vaccinated that are at greatest peril.

Now researchers tell us that so-called "herd immunity" travels even farther. A unique study published in JAMA a few weeks ago compared 22 small communities in Canada where kids were influenza vaccinated to 24 similar communities where they were not, examining rates of influenza in the whole community. Here's what they found: Total community influenza rates were more than double in the unvaccinated group. Immunization of children conferred a large (61%) protective effect for the entire community, providing clear-cut evidence that the benefit of vaccines extends beyond the recipient. Considering that approximately 30,000 people die each year in the US from influenza, this is not trivial.

So now we parents have yet another string of social responsibility to consider: if we forego vaccination for Bobby, what does this mean -- not only for Bobby's classmates -- but also for his grandmother?

posted april 27, 2010

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