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Q&A : Vaccines

4 February 2006

Q1. I understand some vaccines, like the one for polio, might induce the disease instead of preventing it. How can I know if my child is under this risk? Is it safer not to have the vaccine at all?

Virtually every child in this country is vaccinated against various dangerous diseases. Before the availability of vaccines ; every year thousands of children were paralysed from polio. Rubella would cause birth abnormalities in newborns who later became mentally retarded. Diptheria used to be one of the commonest causes of death in school going children. Before the introduction of the Haemophilus Influenza B (Hib) immunization in 2002; the germ Hib used to be the commonest cause of meningitis (infection of the lining of the brain), leaving many children with permanent brain damage. Whooping cough, often described as the 100 day cough disease, would kill many children, most of whom were less than 1 year of age.

Without any doubt, children have benefited more from vaccines than from any other preventative program in medical history.

And because vaccines have been tremendously effective and almost eliminated many of these serious diseases, some parents are beginning to question and reexamine their usefulness.

Do we still need vaccines? Do their benefits still outweigh their risks? The answer to both these questions are an unequivocal YES.

The fact remains that both viral and bacterial diseases that are preventable by vaccines continue to infect children in our country or are only a plane ride away from causing an epidemic. We have to continue to be vigilant in our defense against these multiple killer and maiming diseases and not become complacent by our successes. George Santayana wrote in 1905 “those who cannot remember the past are condemned to repeat it”.

Whether we realize it or not, we take risks in even our most routine of activities. We eat breakfast, even though every year about 200 people are killed when food lodges in their windpipe. We continue to do so because the odds are heavily in our favour. We are willing to take small risks to enjoy huge benefits. Therefore, the question to ask of vaccines is “Do the benefits outweigh the risks?”

The best way to illustrate this would be to narrate the story of the vaccine with the highest rate of side effects; the pertussis vaccine better known as whooping cough.

The old pertussis vaccine was associated with side effects which made some parents choose not to vaccinate their children. And due to the negative publicity of this old vaccine, Japan imposed a moratorium on its use in 1975. Following this discontinuation of the vaccine there were 13,000 cases of whooping cough and 113 deaths. Prior to 1975 there were only 400 cases and no child ever died from the pertussis vaccine!

This clearly and definitively proved that the benefits of receiving the vaccine far outweighed the risks. The choice is much easier for parents today because the new pertussis vaccine has much fewer side effects and is now available for use in all children.

With respect to polio, there are 2 different types of polio vaccines. One is a live and weakened poliovirus vaccine that is given as drops in the mouth (the oral polio vaccine or OPV). The other is a killed poliovirus that is given as a shot (the inactivated polio vaccine or IPV). Routine immunization with OPV have been used since 1972 in this country. This program has been highly successful and there has been no case of polio in Malaysia since the last polio case in 1985.

OPV was chosen and rightly so because it was effective, easy to administer, relatively cheap and induced life long immunity. However OPV is associated with an extremely rare but dangerous side effect. About 1 in every million children given the first dose can develop the disease i.e. become paralysed by polio. This is described as Vaccine Associated Paralytic Poliomyelitis (VAPP).

IPV enjoys the same attributes of efficacy and life long immunity. And added to this, IPV does not cause VAPP and is therefore completely safe. With new advances in vaccine technology and manufacturing, the IPV can now be given in the same injection with other commonly given vaccines. A combination vaccine is available which combines IPV with Diptheria, Pertussis, Tetanus and Hib (5 in 1 combination vaccine) which only requires a single injection.

Q2. I’ve heard that some vaccines might cause brain damage, like the combined measles-mumps-rubella one. How can I know that my doctor can be trusted to administer safe vaccines to my children?

Up till today, there is no convincing evidence that any vaccine can cause autism or any kind of behavioral disorder.

The association of the MMR ( Measles, Mumps, Rubella ) vaccine with autism was first suggested in 1998 when Dr. Wakefield and his colleagues published their paper in the Lancet journal. Based on data from only 12 patients, they hypothesised that MMR caused bowel problems leading to decreased absorption of essential vitamins and nutrients which resulted in autism.

There were many flaws in the Wakefield study. Among others, the claim of autism in the 12 patients was not supported by the author’s own clinical data. At least 4 of the patient’s had behavioural problems prior to the onset of symptoms of inflammatory bowel disease.

Ten of the original 12 authors has issued their retraction from this controversial paper. The editor of the Lancet has issued an apology for publishing the paper. And Dr. Wakefield is being investigated by the UK General Medical Council for unethical medical practice.

Unfortunately, much harm has been done to the noble cause of immunization and protection of our children from these very dangerous disease. The conclusions contained in the 1998 study caused many parents to resist MMR vaccinations for their children.

Many of us, parents included have short memories of deadly measles epidemics; defective rubella babies and children with mumps who become deaf.. We have become victims of our vaccine successes.

In 1990 alone 45 million children suffered from Measles causing 1 million deaths. Before MMR, mumps was the commonest cause of viral meningitis and acquired deafness in children.

In the USA before the introduction of the Rubella vaccine 20,000 children were born annually with Congenital Rubella Syndrome which caused heart defects, deafness and mental retardation in the newborn.

There are numerous scientific data to demonstrate that there is no causal relationship between MMR ( or any other vaccines for that matter ) with autism. The most latest research from Denmark have provided strong evidence against the existence of a causal relationship between MMR vaccine and autism in a population-based study involving more than 500,000 children.

Another fundamental flaw is that natural measles has never been associated with autism. It is therefore extremely intriguing that the vaccine, which is a weakened form of the measles virus can cause autism which has not been associated with the natural infection

And another problem with this hypothesis is that the attenuated (weakened) measles vaccine is associated with a higher risk of disease (autism) than the more virulent wild strain

MMR has been used for well over 30 years. It has had an amazing impact on the health of children. The US and Finland are virtually measles free with the successful 2 dose MMR regimen. Measles is probably the next serious childhood disease to be eradicated following smallpox and polio. And the MMR vaccine has an excellent safety profile. The WHO announced that ”MMR is a highly effective vaccine with an outstanding safety record” over the past 30 years with more than 500 million doses administered.

Our country has been immunising against measles since 1982 and the vaccination of school going girls against rubella was initiated in 1986. This immunization policy was further enhanced with the introduction of the MMR vaccine in 2002. This was undoubtedly a much more effective strategy which would further improve the protection of our children against these 3 serious diseases.

I would advise all parents to ensure that their children receive the 2 doses of the MMR vaccine which is administered at 1 and 6 years of age. Please do not be swayed by the sensationalized vaccine scares which continues to be played up by many anti-vaccine lobbies in cyberspace.

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