Today’s post is a little different. After I describe a recent study in Pediatrics, I’m going to tell another personal story — what happened when I vaccinated my son. Stories from parents about what happened when their children received their vaccines populate all corners of the internet, and I felt it was important to add mine to the mix, especially following this study, for reasons that will become clear.
The study looked at the rates of religious exemptions for immunizations in New York state and then looked at pertussis (whooping cough) rates across the state. Pertussis, or whooping cough, is the bacterial respiratory infection that causes severe coughing for weeks or months and can kill vulnerable individuals, primarily young babies. Religious exemptions are available in 48 states (Mississippi and West Virginia don’t have them), with varying strictness and requirements, for parents who state that vaccinating their children would violate their religion. It’s worth noting that only one major, recognized religion teaches beliefs that may be contradictory to vaccination — Christian Science, which has only 900 to 1,100 churches throughout the entire U.S.. Yet even Christian Science church leaders often encourage adherence to vaccination laws, and outbreaks have started in Christian Science communities. (Contrary to some people’s beliefs, the Amish do vaccinate their children.)
The researchers found that the use of religious exemptions has increased over the past decade in New York, from 0.23% in 2000 to 0.45% in 2011. These are admittedly small percentages, but the percentage of religious exemptions more than doubled in 34 counties (out of 62) over that decade. While the lowest county rate was 0.06%, the highest was a significant 5.6%. In addition, as pertussis rates have increased throughout the U.S. over the past decade, they’ve increased at a higher rate in the New York counties where religious exemptions increased as well. Counties with more than 1% of residents using religious exemptions had 33 pertussis cases per 100,000 individuals, compared to 20 pertussis cases per 100,000 people in counties with religious exemption rates below 1%.
Unsurprisingly, unvaccinated children in New York were at higher risk for pertussis than vaccinated children — 14 times greater risk with 302 cases per 100,000 unvaccinated children, the authors found. But here’s the part of the study that concerned me the most: “High exemption rates in the community increased pertussis risk for both vaccinated and exempted children and especially among vaccinated and exempted children living in counties with high exemption rates (P = .008). In counties with overall low exemption rates, the incidence of pertussis in vaccinated children was not significantly influenced by pertussis infections among exempted children.” (The p value means there is only a 0.8% chance these findings are due to chance.)
I’ve often heard (or read online) parents of unvaccinated parents say something to the effect of, “What difference does it make to you whether I vaccinate? If you vaccinate, my child’s vaccination status doesn’t affect yours.” That’s dead wrong. Especially with a disease as contagious and prevalent as pertussis, and especially given the limited long-term effectiveness of the current pertussis shot, other parents’ decisions not to vaccinate their children absolutely affects my children. It affects my vaccinated child, who is at greater risk for pertussis if herd immunity is reduced, and it puts any babies under 2 months old (when kids get their first DTaP shot) at very high risk for a disease that can kill them — 18 babies died of pertussis in 2012.
While this study does not discuss why religious immunization rates have increased, other studies have shown that parents use medical exemptions to skip public school or daycare vaccine requirements because they have unfounded fears about vaccine safety. Religious exemptions are also frequently (mis)used by parents to avoid vaccinating their children even if immunization would not actually be against the family’s religion. Sometimes, a family seeking an exemption does not even belong to a church; the Internet is full of stories of parents lying to get religious exemptions. They believe vaccines are unsafe or unnecessary, so they seek a religious exemption to avoid school immunizations requirements. Their fears lead to more exemptions, which leads to higher rates of disease, which leads to more death. Pertussis is the only vaccine-preventable disease with an increasing rate of deaths in the U.S. While the increase in pertussis rates is largely due to the long-term waning effectiveness of the current vaccine, this study demonstrates how vaccine fears and exemptions are contributing as well.
And that’s what brings me to my story about vaccinating my son. As I mentioned, the internet is full of parents’ vaccination stories. These stories are earnest, most filled with sadness, tragedy and tears. Unfortunately, nearly all of them inadvertently contain a damaging element of untruth which feeds the fears I described above. That’s why I’m telling my story.
I did not give my son the hepatitis B shot when he was born. I was still uncertain and had not done enough research to feel comfortable with the shot. (Today, however, if/when I have another child, I will have them get the hep B shot at birth.) Yet for the next two months, I lived with a bit of anxiety until his 2-month well-child visit. I lived in Austin, where we have a substantial population of “crunchy” mamas who don’t believe in or fear vaccination and where pertussis rates were accordingly substantial. I had done my research on vaccines with credible (and, for curiosity’s sake, non-credible) sources, and I was confident regarding the overwhelming evidence about their safety and effectiveness. But I was uneasy about the many families in my community who did not believe in vaccines’ safety or effectiveness; they increased the risk of a local outbreak. I was careful about where I took my son and who we visited or who visited us because I was legitimately concerned about the risk my son could contract whooping cough, and die from it.
At his 2-month visit, my son got all the recommended immunizations, plus his first hep B shot. He got the first round of rotavirus, DTaP, Hib, pneumococcal and inactivated polio vaccines. The nurse was impressively fast with sticking those needles in his little legs, and I was unsure how he would react. His face scrunched up, and he cried a little. I nursed him immediately afterward. We left about 15 minutes later. That day, my son ate, slept, cooed and cried like he had the day before. The next day, he ate, slept, cooed and cried as he always had. Over the next several weeks, I noticed nothing unusual. Before long, it was time for his 4-month well-baby. Again, he got all the recommended vaccines. Again, he scrunched his face and cried but only briefly. Again, I nursed him. He slept a little extra that day, but otherwise, nothing unusual occurred. If he had a fever, it was small enough not to be memorable. The days and weeks following his 6-month visit, when he again received all his recommended shots, were similar.
Then his 1-year visit approached. This was the one where he would get his first dose of the MMR, the vaccine that protects against measles, mumps and rubella that so many still worry about because of a long-debunked, scientifically invalid, non-replicated study of 12 children by a fraudulent researcher who lost his medical license. My son would also get the varicella (chickenpox) and hepatitis A vaccines. He received them all. He barely flinched and didn’t even cry this time. I was a little surprised but glad. And that was it. Weeks and months later, my son continued developing as he always had with no noticeable changes, delays or concerns.
It’s not a very exciting story, is it? Honestly, the most “exciting” part was my anxiety: the stab of uncertainty I had before each round of shots, despite my knowledge of vaccine safety (after all, I’m human, and my amygdala is just as powerful as anyone else’s), and the worries I had about him actually contracting pertussis before his 2-month shots or measles before his 1-year shots. The latter was far less likely, but it was not impossible. Despite the lack of drama in my story, however, mine is the more common story.
What about those other stories I mentioned? Most of them are “vaccine injury” stories, describing a disease or injury or disorder that reportedly resulted from a vaccine (I’ll get to that in a moment). If you added up all the stories you read on the Internet in two columns — the “vaccine injury” ones and the “I got my kid’s shot and nothing happened” ones — the former would outweigh the latter by several hundred. Yet this lopsided proportion does not reflect reality. The reality is that millions of children get their recommended shots every year and nothing special happens. Many cry. Many suffer a fever. Many sleep for longer. Many have soreness and redness at the injection sites. Some experience a high fever or sleep heavier than usual for a few days. And nearly all are a heck of a lot more protected from the diseases that ravaged past generations.
Those diseases still ravage some families, all across the world and even in the U.S. Sadly, though, if you search for the stories of families where a child suffered from a vaccine-preventable illness, even these would not (yet) outweigh the misleading “vaccine injury” ones, yet more children become sick and even die of vaccine-preventable illnesses, even in the U.S., than suffer a serious side effect from a vaccine. That’s just not the story Google tells in the new “information” age where everyone, for better and for worse, has a voice and a story to tell. The problem with these “vaccine injury” stories is that they perpetuate beliefs about the safety of vaccines that are inaccurate and dangerous. The “damaging element of untruth” I referred to is the fact that the injury being described, in 99.9% of them, had nothing to do with a vaccine. Whatever injury, disease or disorder the parents are describing is almost certainly real. It also certainly causes the child and the parents pain and difficulty, and the suffering for the child and the parents is undeniable and tragic. And the injury and suffering have nothing to do with the fact that the child got their vaccines around the same time the condition’s symptoms showed up.
There are real risks to vaccines and real injuries that can result from them. I’ve written about them in this blog, and most of the serious ones (things other than fevers, soreness, sleepiness, etc.) occur to about fewer than 1 in a million children, or even 1 in 10 or 100 million, depending on the vaccine and the side effect. But those facts are not part of the reality portrayed in these many unfortunate stories online. Humans often have a hard time accepting coincidences as… coincidences. Parents want an answer and then make the mistake of presuming that vaccines caused whatever disorder, disease or other health problem the parents have described.
But consider this scenario: If a parent took their child to the 6-month well-baby visit and got their shots, and then visited a friend’s house a week later, where the baby got nipped by an overprotective dog, chances are pretty slim that the parent would draw a connection between the dog bite and the vaccines. The parent likely would not even think about the pediatrician visit. If someone else brought it up, just about any reasonable, rationally thinking parent would consider it a coincidence that the dog bite happened within a week of the vaccinations.
Not so when it comes to countless illnesses or disorders that have been inaccurately and inappropriately linked to vaccines, such as autism, ADHD, asthma, brain damage, eczema… the list goes on. Yet dozens and dozens of studies have found, using appropriate scientific methods with millions of children from all sorts of populations, that vaccines do not cause these and other health issues. Most often, there is not even a biological mechanism that makes it possible for the vaccine to cause the condition in question. The disorder or injury the child is suffering is no less a coincidence than a dog bite, a car accident or any other unfortunate incident that might happen in the weeks following vaccination. The tiny handful of serious risks that can be caused by a vaccine, usually to an already immune-compromised child, are so rare that a child has a greater risk of contracting a vaccine-preventable illness, whether it’s an endemic one like pertussis or one brought over from an outbreak like the huge measles one in the UK right now (or the smaller one currently in Brooklyn).
Again, people have a hard time with coincidences. They want to believe they are something more than a mathematical reality, and their personal experience feels like it trumps the mountains of scientific information showing that a vaccine didn’t and cannot cause what they think it did. So they share their “vaccine injury” story, feeding unfounded fears that ultimately put my vaccinated child, and millions like him, at risk.