Childhood Vaccinations
What Every Parent Should Know

BY RICHARD B. GOLDBLOOM, M.D.

NO MATTER how you look at it, immunization is one of this past century's medical miracles. Smallpox, which killed two million as recently as 1967, no longer exists. Polio, down by over 90 percent worldwide, has been eliminated from the western hemisphere.

 
MEASLES deaths have been cut by 95 percent in the industrialized world. And cases of Hib (Hemophilus Influenza Type B) disease, the most common form of childhood meningitis, have decreased by over 90 percent this past decade to just 60 cases a year in Canada as the number of babies vaccinated has increased.

       Similarly, vaccines have reduced cases of pertussis (whooping cough) from two million in 1980 to 346,000 in 1998 globally and have prevented more than 700,000 child deaths and 50,000 maternal deaths annually from tetanus. Fully 80 percent of the world's population has been inoculated against diphtheria.

       In the years before immunization, I lived through epidemics of these diseases and saw children die or become permanently disabled. Yet some parents are still reluctant to fully immunize their children. Some think such diseases aren't a threat because nowadays they're rarely heard of. Others weren't immunized when they were children ("I never had shots and I'm okay"). And some parents are just plain misinformed by antivaccination activists -- who, by peddling their distorted ideas through the media, place their own and other children at serious risk.

       Yet damaging diseases can reappear whenever people remain unimmunized or underimmunized. Paul Hazen and his wife, Rin, who is Thai, live in Richmond Hill, Ont. When Rin was two months pregnant with their second child, she developed a rash. Her doctor thought it was an allergy, but when Vanessa was born, she was covered with blueish-red spots -- evidence of congenital rubella (German measles). Rin's rash had been a symptom of the disease; growing up in Thailand, she hadn't been immunized. Ultimately Vanessa was found to be profoundly deaf and almost died of pneumonia at four months. She needed a feeding tube until she was four years old.

       "It was the toughest thing I've ever gone through," Paul says. Vanessa is now in prekindergarten. Her hearing has improved, but she still needs daily one-on-one specialist instruction. For this couple, the lesson was clear. "Immunization should be mandatory," says Paul. "Parents can take nothing for granted."

       Unfortunately, immunization's enormous success has produced a false sense of security. "And when too many parents opt out of vaccinations," reports Dr. John Clements of the World Health Organization (WHO), "they leave their children exposed to new epidemics."

       Indeed, a 1998 Canadian survey showed that 20 percent of two-year-olds hadn't received all their shots of the DPT vaccine that protects against diphtheria, pertussis and tetanus (lockjaw); ten percent had not received recommended doses against polio; and five percent hadn't been immunized against measles, mumps and rubella with the MMR vaccine. Only 73 percent had been fully immunized with Hib. An unvaccinated child exposed to any of these diseases is far more likely to contract it.

       Here is what every parent must know to distinguish fact from rumour:

 
Vaccines are safe.

IN FEBRUARY 1998 an international medical journal reported a possible link between the MMR vaccine and inflammatory bowel disease and autism. This has since been completely disproved by two independent British studies and research done in Sweden that has been accepted by the British Medical Research Council, WHO and the U.S. Centres for Disease Control and Prevention. Millions of children have been successfully and safely immunized with MMR. Still, thousands of parents in Britain refuse the shot.

       Dr. David Scheifele, director of the Vaccine Evaluation Centre at B.C. Children's Hospital in Vancouver, says: "This is a perfect example of how poorly founded allegations can harm public confidence. In fact, when the incidences of inflammatory bowel disease and autism were carefully examined, there was no difference in frequency between immunized and nonimmunized children."

       For some parents, it takes no more than a mention of risk to make them gun-shy about vaccinations. Jo-Lynn and Bruce Fenton of Bedford, N.S., have two sons: Liam, six, and Rhys, three. When both were diagnosed as autistic, their parents read books and searched the Internet to find out what could have caused this distressing condition.

       Before Liam's autism was diagnosed, the couple had had no concerns about having their children immunized. Liam received all his immunizations as a baby and Rhys had got his first three DPT vaccinations. But at the mere suggestion of a link between MMR and autism in what they read, they held off getting Liam his school-entry booster and Rhys his MMR. "Our family doctor and our pediatrician have said there's no evidence of a link," says Jo-Lynn, who as a baby wasn't immunized. "But I just don't want to do anything that might make their condition worse. I don't know what to do, really."

       Parents like Jo-Lynn and Bruce need the most accurate and reliable information that is available. Most vaccines' side effects are minor and transient -- a sore arm or a mild fever. Serious reactions such as seizures are one in thousands, and the risk of permanent damage or death is one in millions. As Dr. Scott Halperin, a leading Canadian authority on vaccines, puts it: "The risk of death is similar to that of dying from a lightning strike or tornado."

 
North American children are still in danger.

IN RECENT years, vaccine-preventable diseases like diphtheria and polio, thought to be a thing of the past, have reappeared in countries that haven't immunized part of the population. Take the former Soviet Union. Due partly to a breakdown in public-health services, diphtheria cases surged from some 1,500 in 1990 to nearly 48,000 in 1994 -- with 1,700 deaths. At least 20 cases were imported to western Europe. With the growing number of global travellers, we have a responsibility to see that all children everywhere are fully immunized.

       Manitoba has experienced two serious outbreaks of congenital rubella in the past decade -- in 1992-93 (1,200 cases) and in 1997 (a whopping 3,914). Dr. Digby Horne of Manitoba's Health Department says this is because prior to 1983 it was thought that only girls needed rubella immunization. Some of the many unimmunized males in the population caught rubella and transmitted it to pregnant unimmunized women.

       Measles, one of the most infectious viruses known to man, kills up to a million children worldwide every year. In Canada in 1940, there were about 700 cases for every 100,000 population. Then, in the 1960s, measles vaccine was introduced -- and by 1998 there were only 12 cases. Of those, five had travelled outside Canada just before the disease's onset, and the others weren't fully vaccinated.

       Although virtually all countries have established immunization programs, in many the number of people fully immunized falls short of what it takes to eliminate disease. As a result, measles is still prevalent in many African and South Asian countries.

 
Children need and deserve protection.

ONE OF the most dangerous sources of misinformation about vaccinations is the Internet, where antivaccination activists prey on an unsuspecting public. Dr. Scheifele calls this rumourmongering of the worst kind. Some web sites dedicated to opposing immunizations have authoritative titles like "National Vaccine Information Centre." Typically, these sites report horror stories of children allegedly damaged by immunizations, but site visitors are told nothing about the credentials of these merchants of fear.

       Dr. Gerry Bohemier, a Winnipeg chiropractor, is an outspoken immunization opponent. He claims it's "a personal choice, a matter of freedom" for parents. None of his four children, now 13 to 21 years old, has been immunized. His nonprofit Eagle Foundation raises money to help families with alleged vaccination injuries seek compensation from the courts.

       It has supported two such cases so far, neither of which has yet to come to trial.

Related Links The following links are for informational and educational use only. Reader's Digest does not endorse or guarantee any infomation contained therein. For diagnoses and treatment of any illness, always consult a health-care professional. Canadian Paediatric Society Vaccination schedule, common questions and answers and more. Health Canada, Division of Immunization Immunization misconceptions, vaccination schedule, general information, information for health professionals. World Health Organization Information, listed by disease, about each vaccination preventable disease, parents' questions, immunization safety. Canadian Immunization Awareness Program Information, resources, schedules, questions & answers and more.

       Bohemier's views conflict with those of virtually the entire medical scientific community. When challenged, for example, with the fact that paralytic polio has almost disappeared from the face of the earth since the advent of polio vaccine, he makes the bizarre claim that "the definition of polio has been changed."

       Bohemier often quotes an anti-vaccination book by Viera Scheibner, an Australian who calls herself a medical researcher. Vaccination: 100 Years of Orthodox Research Shows that Vaccines Represent a Medical Assault on the Immune System reportedly was paid for and distributed by Scheibner herself. I could find no record of her publications in peer-reviewed scientific literature of the past eight years. One of Scheibner's distinctions is to have won the Bent Spoon Award from the Australian Skeptics society, presented annually to the "perpetrator of the most preposterous piece of pseudoscientific piffle." Still, about 10,000 North Americans buy her book each year.

       The net result of the harangues of antivaccination activists is that some children are denied the protection they need and deserve.

       The success of Hib vaccine against meningitis is just one of many medical triumphs of this past decade. But tragedies still occur when children go unprotected. Penny and Lyall Langlois of Pembroke, Ont., have three children: Alexandre, five, Austin, three, and Sarah, 19 months. The boys received all their immunizations, but somehow Sarah missed out. "We just kept finding excuses to postpone it,'" Penny, a youth counsellor, remembers. "Also, people I knew seemed to have a strong case against immunization. They gave me a pile of reading material. And some 'very organic' friends at work said, 'You're putting poison into your children.'"

       One day last October, Lyall, Alexandre and Sarah got sick with what seemed like the flu. Sarah became very lethargic. Three hours after admission to the hospital, where she was diagnosed with meningitis, she stopped breathing and had to be intubated. Fortunately, she survived, but her recovery is far from complete. After two months of therapy, Sarah began to crawl and sit again, but has not yet recovered her ability to stand. The Langloises know occupational therapy will be a long road.

       Penny's antivaccination friends still don't believe Sarah's illness was due to not being immunized. "These people have strong beliefs," says Penny. She and Lyall, both puppeteers, will be holding shows across Canada this year to teach the importance of vaccination. "Think of all the good we can do if every child in Canada is fully immunized," says Penny. "What happened to us could happen to any family."

 
DR. JANE WECKMAN, too, is a passionate advocate of immunization -- also because of personal experience. The 51-year-old Halifax pediatrician says she was born "two years too soon" -- before the introduction of polio vaccine. She contracted polio at age three. "After a few days, I couldn't walk and I had trouble breathing," Weckman remembers. Fortunately, she soon recovered and went on to live an active life -- until 1991.

       That year Weckman noticed pain in her hips, arms and shoulders, then began having spasms in her legs and back. Doctors recognized "post-polio syndrome," which up to half of polio survivors can develop 20 to 40 years later. Although Weckman has improved with treatment, she can work only part-time and can no longer cycle, ski or golf.

       "As a pediatrician," she says, "I've seen families opposed to immunization because of religious beliefs or a desire to be 'natural and pure.' But most of them were convinced to protect their children when I told them my story."

       Since 1978, Holland has had two polio outbreaks -- both exclusively among people who refused vaccinations for religious reasons. There were over 180 cases and several deaths. In Canada, polio was seen in 1993 in an Alberta religious community opposed to vaccination. This sect had fuelled the previous Canadian outbreak, in 1978, when polio was imported from Holland by sect members. Eight people were left paralyzed.

 
THE MESSAGE for parents is clear: If you want all children to grow up healthy, make sure yours are immunized and receive all the necessary booster shots. Consult your doctor, keep a vaccination record and know when the next ones are due.

       Reliable, scientifically proven information is available from several sources, including books such as "Your Child's Best Shot," edited by Dr. Ronald Gold and available through the Canadian Pediatric Society, and "What Every Parent Should Know About Vaccines," by Dr. Paul Offit and Dr. Louis Bell.