PT Classroom - A Review of Immunizations for Healthcare Professionals: Requirements, Advantages and Dangers ׀ by  Erica Cannizzo, DPT

Raising a child requires attending to their needs as vulnerable beings. This includes feeding, sheltering, nurturing, and protecting them from harm. There are many dangers in the world and one serious hazard is disease. Humans are resilient and intelligent creatures; and will go to great lengths to ensure the survival of our species. Pathogens such as viruses are capable of mass extinction and this threat has motivated humans to create a protection against these virulent microorganisms. Viruses evolve more rapidly than humans and although the immune system is adaptable, people are not born with an inert protection against viruses. In fact, children are the most defenseless against viral infection. People are typically vaccinated before they are able to consent and on rare occasion vaccines have been reported to be more harmful than helpful. Despite the risk of adverse side effects, vaccines have saved generations of children from debilitating and deadly diseases.

Immunization is the process whereby a person is made resistant to an infectious disease, typically by the administration of a vaccine. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or disease. Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to prevent between 2 and 3 million deaths each year. It is one of the most cost-effective health investments, with proven strategies that make it accessible to even the most remote and vulnerable populations. In the United States, it is required that children have 36 vaccinations to enroll in public or private schools and most are administered before the child is 12 months old. These include Diphtheria, Tetanus, Polio, Haemophilus influenzae Type B, Hepatitis A and B, Measles, Mumps, Rubella, Meningoccocal, Pheumonococcal, and Varicella.

Vaccines contain many ingredients that make them safe and effective, including preservatives, adjuvants, and other ingredients. Thimerosal is a mercury-containing preservative used in some vaccines and other products since the 1930s and is very effective in preventing bacterial contamination of the vaccine liquid. Understandably, some people believed that the mercury in thimerosal was harmful. The most extreme opponents of thimerosal believed it was the cause of their childrens’ autism, despite the lack of scientific evidence supporting the notion. In July 1999, the Public Health Service agencies, the American Academy of Pediatrics, and vaccine manufacturers agreed that thimerosal should be reduced or eliminated in vaccines as a precautionary measure. 
Since that time, studies have found that there is no convincing scientific evidence that the low doses of thimerosal in vaccines causes harm, except for minor reactions like redness and swelling at the injection site. Since 2001, with the exception of some influenza vaccines, thimerosal is not used as a preservative in routinely recommended childhood vaccines. Yet, the rates of disorders speculated to be caused by these ingredients, such as autism, have not gone down.

Autism leads to considerable difficulties for the families of these patients because many of them remain dependent throughout their lives. Special education costs can exceed $30,000 per year. The annual cost of care in a public school may be as much as $80,000-100,000. Children with autism require around-the-clock care, and parents of these special children report a challenge in finding knowledgeable and sympathetic health care providers. There are also challenges in finding reliable and valid information about autism etiology, treatment, and prognosis. Parents also report frustration in seeing their child change from being active and engaged to being apathetic and nonresponsive. Parents blame vaccine administration for the onset of these symptoms.

Given the lack of direct evidence for a biological mechanism and the fact that all well-designed epidemiological studies conclude that there is no causation between thimerosal and autism, the literature recommends that cost-benefit assessments regarding the use of thimerosal-containing vaccines versus thimerosal-free vaccines and other biological or pharmaceutical products, whether in the United States or other countries, should not include autism as a potential risk.

Another ingredient of vaccines is aluminum salts, which help create a better immune response and decreases the number of doses for protection. Everyone is exposed to mass amounts of aluminum in the earth’s crust; it’s present in our food, air and water, including breast milk and formula. Aluminum has been used and studied in vaccines for 75 years and is safe. Parents should be reassured that quantities of mercury, aluminum, and formaldehyde contained in vaccines are likely to be harmless on the basis of exposure studies in humans or experimental studies in animals. Although severe anaphylactic reactions may occur rarely after receipt of vaccines that contain sufficient quantities of egg proteins (ie influenza) or gelatin (ie, MMRII), children who are at risk for severe infection with influenza can be desensitized to influenza vaccine, and gelatin-specific allergies are very rare. Immediate-type hypersensitivity reactions to neomycin or yeast proteins have not been clearly documented and remain theoretical.

Public paranoia over the perceived risks of vaccines has increased despite advances in vaccine safety. Social media, such as the Internet, provides an easy way to obtain information regardless of its reliability and many sources present opinions as facts. Such is the case with celebrity opponents like Jenny McCarthy who proliferate the anti-vaccine message. Vaccine fear is also expressed as the social anxiety over technology and modernization. There is much distrust over poorly managed health risk issues making it more difficult for governments to facilitate trust. There is also a skeptical view of the financially motivated pharmaceutical companies. Despite these issues, there needs to be more emphasis on education and the factual basis of such theories. There is a complex and deeply rooted culture of vaccination-resistance in this country. It is important for physical therapists and all health care providers to recognize these anxieties and respond to them with evidence in both the public and clinical encounter. Vaccination’s goal of disease prevention must be the primary message to the public. Health care professionals need to address patient concerns about vaccine safety with tolerance and respect. This includes the willingness to provide detailed information about both the risks and benefits of vaccination.