Missed vaccines weaken 'herd immunity' in children
Missed vaccines weaken 'herd immunity' in children
By Liz Szabo, USA TODAY
Brendalee Flint did everything she could to keep her baby safe. She nourished her with breast milk; she gave her all the routine vaccines. But Flint never realized how much her daughter's health would depend on the actions of her friends, neighbors and even strangers.
By 15 months old, Flint's daughter, Julieanna Metcalf, was walking, exploring and even saying her first few words. Then one day in the bath, while fighting what seemed like an ordinary stomach bug, Julieanna became so weak and floppy that she couldn't hold up her head.
PHOTOS: Glimpse into Julieanna's life now
CHART: See how vaccines have changed disease rates
HOME-SCHOOLING: Some parents do it to avoid vaccinating kids
"She couldn't say 'Help me,' but her eyes were begging me to do something," says Flint, 35.
Flint rushed the baby to the hospital, where she was diagnosed with meningitis, a swelling of the lining of the brain, caused by a severe case of Hib, or Haemophilus influenzae type b. Julieanna was one of five children in Minnesota hospitalized with Hib in January 2008, the state's biggest outbreak since 1992.
Three of the other Minnesota children hospitalized for Hib were unvaccinated, including one who died, according to the Centers for Disease Control and Prevention.
Experts worry that such outbreaks — along with mumps outbreaks on the East Coast and more than two dozen measles outbreaks around the country in 2008 — represent cracks in the country's protection against terrifying childhood diseases that were once virtually eradicated.
Parents who have never seen their children gasp for breath no longer fear these diseases and, in some cases, are delaying or skipping immunizations, says Paul Offit, chief of infectious diseases at Children's Hospital of Philadelphia. Many parents who reject vaccines do so because of the mistaken notions that they cause autism or overwhelm the immune system, Offit says.
That worries moms such as Flint, who learned that her daughter has a rare immune deficiency only after she contracted Hib. Because Julieanna doesn't respond to vaccines, she depends on other parents to keep germs out of circulation by vaccinating their kids, a phenomenon called "herd immunity."
Now, Flint and a growing number of parents as well as a handful of celebrities are speaking out about the human toll of infectious diseases and the consequences of refusing vaccinations. Through groups such as Every Child by Two and Parents of Kids with Infectious Diseases (PKIDs), they're telling their stories to lawmakers and on social-media sites such as YouTube.
Olympic gold medalists Kristi Yamaguchi and Sheryl Swoopes now promote flu shots, especially for families with children. Actress Keri Russell promotes whooping cough booster shots for parents of newborns.
"I just want everybody to know what can happen if you don't vaccinate your baby," Flint says. "It's not just your kid. When you get your child vaccinated, it helps to protect the other kids who don't have the ability to protect themselves."
During the 2008 Hib outbreak, Flint's daughter began having seizures at the hospital, and doctors had to operate on her brain. They made an incision in her skull from one ear to the other. A priest performed a second baptism.
"I still remember walking her to the surgery room and giving her to the doctor," Flint says. "I didn't know if I would see her again."
Thanks to the success of vaccines, few parents today know anyone who has become sick with a serious contagious disease, says William Schaffner, an infectious-disease expert at Vanderbilt University School of Medicine. Instead, parents are often concerned about chronic illnesses, such as asthma, allergies or autism, which don't have a clear cause.
Some choose not to vaccinate
Perri Dorset of New York City says she has done her own research, both online and in magazines, into the best way to vaccinate her 2½-year-old daughter.
Dorset didn't believe shots against hepatitis B or swine flu were necessary, and she feared that the new H1N1 shot could pose unknown risks. Dorset also spaced out her daughter's vaccines, administering shots over a two-year period that usually would be given within the first six months.
"I just didn't see the need to give all these shots early on," Dorset says.
Parents such as Rebecca Estepp of San Diego decided not to vaccinate her younger son after his older brother was diagnosed with autism. When measles broke out in Southern California in 2008, "I had to decide, 'Would I rather have him get the measles or risk having him get autism like his brother did?' " says Estepp, national policy manager for Talk About Curing Autism. "My husband and I decided we'd rather he get measles."
Nationwide, the number of children exempted from school immunization requirements has grown by 50% since 1991, to 1.48% in 2004, according to a May article in The New England Journal of Medicine.
Exemption rates are alarmingly higher in pockets of the country, however. In Ferry County, Wash., 27% of children have a non-medical exemption from school vaccine requirements, the article says.
These are the types of communities where imported diseases take hold and spread, says Lance Rodewald of the Centers for Disease Control and Prevention.
Nearly 30% of patients in the current mumps outbreak — which has hit communities in New York state, New Jersey and Quebec — failed to receive one or both recommended shots. And more than 90% of victims in the 2008 measles outbreaks, which sprouted up across the USA, were either unvaccinated or had unclear vaccination records, the CDC says.
A study published Monday in the Archives of Pediatrics & Adolescent Medicine found that unvaccinated children are nine times as likely as others to contract chickenpox — which killed 100 children and hospitalized 10,000 a year before a vaccine became available in 1995. The same authors found that unvaccinated kids are 23 times as likely to develop whooping cough.
Danielle Romaguera's daughter, Gabrielle, was only 7 weeks old when she died from whooping cough — one week before she would have received her first shot.
Shannon Duffy Peterson of Minnesota says she realized the dangers of diseases such as chickenpox and pneumococcus only after her children became ill. She didn't vaccinate her son or daughter against either disease after their pediatrician said the shots weren't needed.
In 2001, both children were hospitalized because of a bacterial illness called invasive pneumococcal disease. Her 5-year-old son survived. Her daughter, Abigale, who was two weeks shy of turning 6, died.
"I can't tell parents enough the importance of vaccination," Peterson says in video on the PKIDs website. "I hope that no one else has to hold their child when they die."
Lingering effects
Julieanna spent a month in the hospital, mostly in intensive care. By the time Julieanna left the hospital, she had lost the ability to walk, talk and even swallow.
"It was like having a newborn again," Flint says. "I would rub her throat for swallowing and rub her cheeks for chewing. She couldn't crawl. She could scream, and that was about it."
Two years later, Julieanna still needs weekly injections to prop up her immune system — and might for the rest of her life, Flint says.
Although Julieanna has relearned how to walk, she often falls, Flint says. She attends special-education sessions, as well as physical therapy, speech therapy and occupational therapy.
Flint says she lives with the fear that Julieanna will suffer from lingering brain damage, as well as the knowledge that she remains vulnerable to a host of germs carried by her classmates.
"I don't know if she will grow out of this," says Flint, who spoke to Congress about vaccines in May. "I wish I could see what the future will be."
Schaffner says he sees vaccination as a part of the obligation of the strong to protect the weak.
"We all have to be protected, so the virus can't find these babies," Schaffner says. "We have to provide a cocoon of protection around them. We surround them with strength. I find that to be part of our responsibility. We cannot think just about ourselves."
Vaccines have nearly eliminated some diseases
Before vaccines became available, hundreds of thousands of Americans — including thousands of children — routinely came down with dreaded infectious diseases each year. Although vaccines have nearly eliminated many of these diseases, doctors say outbreaks in unvaccinated communities put everyone at risk.
Avg. annual cases, before vaccine - Peak annual deaths, before vaccine - Decline in cases - Decline in deaths
Vaccines approved before 1980
Diphtheria 21,053 3,065 100% 100%
Measles 530,217 552 99% 100%
Mumps 162,344 50 96% 100%
Polio 16,316 5,865 100% 100%
Rubella (German measles) 47,745 2,184 99% 100%
Tetanus 580 511 93% 99%
Whooping cough 200,752 7,518 92% 99%
Vaccines approved after 1980
Chickenpox 4,085,120 138 85% 82%
Hepatitis A 117,333 298 87% 87%
Acute hepatitis B 66,232 267 80% 80%
Hib 20,000 Not available 99% 99%
Invasive pneumoccal disease 63,067 7,300 34% 25%
Source: The Journal of the American Medical Association
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