Vaccines

The recent spate of measles cases traced to Disneyland (my sense of poetic justice is amused) has brought the issue of vaccination into the news.  When my son was little, I was totally OK with the vaccines that were recommended at the time.  Now I’m not so sure.  Let me explain….

One of my childhood memories is looking over my father’s shoulder at the records he kept of my vaccinations.  I apparently received a whole pile of them on the day I was born: I must have been a little pincushion.  I was glad that it happened when I was a baby, so that I didn’t remember it.

When my son was born in 1985, the vaccine regime hadn’t changed much.  The vaccines were the same as I had seen in my childhood records:

  • Oral polio vaccine
  • Diphtheria/pertussis/tetanus (DPT)
  • Measles/mumps/rubella (MMR)

I remember that there was an organization of parents whose children had not reacted well to the DPT shot, but the numbers of children affected overall were vanishingly small, so I had no objections to vaccinating my son.

A little later, a vaccine came out for:

  • Haemophilus influenzae type B (HiB) (interesting that it doesn’t have a simple name in English like the others)

and my son received it.

A vaccine for;

  • Varicella (chicken pox)

came out a little later, but my son had already had chicken pox, so he didn’t need it.

But time and Big Pharma have moved on, and the recommended vaccine lineup now includes, in addition to all of the previous:

  • Hepatitis A
  • Hepatitis B
  • Rotavirus
  • Pneumococcal disease
  • Infliuenza (‘flu shot’)
  • Meningococcal disease

I’m compelled to wonder if it’s all necessary.  Other than the flu, I’ve never heard of the diseases and viruses in the post-1980s group representing public health problems.  And I have to wonder if there is a point of diminishing returns where the side effects of the vaccines become worse than the diseases they are intended to prevent.

I had a case of the chicken pox when I was six; my son had it when he was eight.  I’ve considered it somewhat of a rite of passage: this is what a ‘real disease’ feels like.  A vaccine to prevent it seems more a convenience than a real public health necessity.

And then there is the specter of autism.  We’re told that there was one study relating vaccines to autism; it was debunked and retracted; so don’t consider the possibility anymore.  But one in 2000 children or so had something resembling autism in the 1970s, now it’s one in 68 in the US.  And maybe vaccines didn’t have anything to do with it, but there are too many reports of parents seeing the spark die in their children’s eyes immediately following vaccination.

On one level, I don’t have to worry about this personally anymore. But sometime in the next 5-10 years (I hope), my son will get married and have children.  I can’t advise him, as my parents might have advised me, not to worry and proceed with the usual series of vaccinations.  (Indeed, I hadn’t asked my parents at the time, as I didn’t consider the matter to be controversial.)

Telling him to exercise judgement over which vaccines his child should receive isn’t a practical option either.  The data he’d need for an informed decision aren’t readily available, and he’d likely get into arguments with his child’s doctor.  But beyond that, New York state law requires children to be immunized against almost all of the diseases and viruses listed above (the exceptions today are Hepatitis A, rotavirus, influenza, and meningococcal disease), in order to attend school.  One can assert a religious exemption, but it would have to apply to all vaccines, which isn’t prudent either.

I can’t get upset about parents who refuse vaccinations for their children.  I live in New York City, and people come here from all over the world, some vaccinated, some not, and life goes on.  Ultimately, access to clean water and proper sanitation is more important to public health than this or that vaccine.  And if an enemy wanted to conduct biological warfare using some exotic virus, all the childhood vaccinations in the world wouldn’t help.

What was a simple and noncontroversial decision in the 1980s has become a minefield.  And I don’t have any magic way out.

5 thoughts on “Vaccines”

  1. Which vaccines are necessary and the schedule for their administration are valid questions. I’d like to see how many people would be diagnosed with autism spectrum disorders based on standards that existed in the past, maybe at ten-year intervals. It used to be that only the most severely affected people were diagnosed as autistic. Expanding the number of autism spectrum disorders has to increase the number of people diagnosed. There are also the perverse incentives of access to special education programs and Social Security disability payments to encourage parents to obtain the autism diagnosis for their children, if only in a mild form. The first Diagnostic and Statistical Manual of Mental Illnesses was a pamphlet. The current version (DSM-V) is a doorstop of a book.

    I tried to get a shingles vaccination a while back. I learned that it needs to be prescribed rather than just requested, as one can do with flu vaccine. I am old enough to get shingles, which is how chicken pox manifests itself in adults who had chicken pox, and it can be quite painful. A friend of mine showed me a rash that he had some years ago, and I recalled the picture from health class of someone with shingles, and took him to a prompt care place. I was right.

    Vaccines aren’t 100% effective, and the number that I’ve read is 80-85%, and somewhat less for flu vaccine. Still, we benefit from herd immunity, which requires that at least some children be vaccinated. The goal of vaccination is less to keep an individual person from getting sick than to prevent an outbreak of whatever disease is being immunized against. We’re probably both old enough to remember when a lot of our class was out with whatever disease.

    Other reasons for the push for vaccination are the rise of the two-income family and single parent families. Mom isn’t available to be home with a sick child. Day care centers won’t take a child with a temperature above a certain level, or at least that is what I am told. Decline in employee benefits that cut or eliminated paid leave also increases the number of sick children who are attending school, potentially infecting other children as the parents, who go to work, have an opportunity to infect unimmunized adults.

    The Army likes to immunize against everything, so I was surprised to learn that a cholera vaccination was not on the list of required vaccinations for people who are going to Afghanistan. It used to be on the list of required vaccinations in the 1960s for people who were going to Korea and their families who were accompanying them.

    I also enjoyed the irony of having measles appear at Disneyland, but it is not all that surprising. Friends of mine who are seasoned Disney veterans tell me that everything must be bought in advance, and the refund policy is not generous. If you are taking three or four people, just the airfare can be a lot of money. If you don’t take the “Disney experience” and stay in a Disney hotel, your day begins with a long trek from the parking lot to the park. Even when you do stay in a Disney property, which usually allows you to avoid renting a car, the shuttle buses are a long trip.

  2. I agree with your suspicion that part of the rise in autism is that the definition has become broader. But I don’t believe it explains everything.

    When I got the chicken pox, my mother diligently kept me out of school until my doctor confirmed I could go back. But when I got to the third grade, everyone else in the class got chicken pox, and there were a few days when half the class was out sick.

    You’re right that it’s a real hardship for many parents to take a few days off to look after a child with chicken pox: it’s another measure of how the world has become a harder place. It says something that we’re now vaccinating against an illness, not because it’s life-threatening, but because it causes economic loss.

    I went to Disney World–once–at my wife’s suggestion. It was one of the most expensive vacations I’ve ever taken: two weeks in Paris (on the level that my wife and I like to travel) is cheaper than five days at Disney World. Between the cost and having to disappoint one’s children, I can understand how parents might elect to go there anyway. A sensible alternative would be for Disney to tweak its policies to allow a family to reschedule their Disney outing due to illness, but I’ll be surprised if they actually do it.

  3. The rise in autism might not be entirely explained by expanded numbers of classifications, but I think that it is a majority of the change. People who used to be seen as weird kids now get mental illness diagnoses that can follow them for life.

    Had I been the chief of Disney’s PR department. I would have given people vouchers for their trips provided that they could present current immunizations for the child or children who got sick. An odd thing that my Disney veteran friend told me is that the Disney credit card, which is issued by some bank, will not give you a cash refund if you return things that are bought on that credit card. He might be confused, because most bank-issued affinity cards will refund the credit balance if you ask. Maybe Disney really is different. He is trying to get me to go to Disney World, but I told him that my appearance fee at Disney World is $10K per day plus first-class airfare, all meals, and my choice of room in their best hotel. The irony is that he goes because his wife, who is in her fifties, is a Mickey Mouse fiend. He would do well to buy Disney stock.

    Even when people have sick and vacation time, it’s hard to build it up. I argued for employee’s choice on compensatory time for when we have to work scheduled overtime, which is about 4 hours every month, more to benefit a co-worker than myself. Compensatory time turns into regular pay after a year. Though he got credit for his military time, it doesn’t advance the rate at which he earns sick and vacation leave until he “buys back” the military time, which works out to paying about 10% of his salary into the pension plan. This can be done over a year or more, but he doesn’t get increased leave credit until the time is bought back. It’s worth doing. If he got at least three years of service credit, he would move from 104 hours of vacation time annually to 160 hours. Sick leave stays at 4 hours a pay period, or 104 hours per year, regardless of how long you work for the government.

  4. I can’t say whether there is or is not a link between childhood vaccines and autism, but it’s become one of those subjects that is dominated in the public discourse by conflicting groups, each with its own ax to grind. It’s hard to get a straight answer.

    You should go to Disney World–once. Consider it research into the American culture. And you will want to stay in ‘their best hotel.’ Otherwise, the place is Shuttle Bus Hell.

    When I first started working at NYC Transit, I took a half-pad of sick leave forms home the first week. The first time I needed one was three years later, and the form had been redesigned. But then again, I was in my early 20s, and indestructible.

  5. Based on what my friend has told me, Disney is not the place for me. The idea of dragging myself around, paying to get into what is essentially a shopping mall, and being around children of all ages just makes my blood run cold. I do not need to travel to know that people are nuts.

    To make Disney even less desirable, I’m on shift work, which makes my temper shorter than usual. I just finished 4 days on night shift. Now I have 7 days off and do another three nights, then have two days off and work two weeks of 10-hour days, which is our normal schedule where I work. I would prefer to work four on, four off, three on, three off. Even the complementary schedule, four off, four on, three off, four on would reduce the need to work 60 hours in six days at least half of the time. I work shift 57% of the time, because we have 7 people among whom the coverage is shared. It works out to being on shift 8 of 14 weeks. My boss thinks that having seven days off is some big bonus, but it’s just rearranging the deck chairs on the Titanic. I don’t want to come back to work exhausted. To make things more interesting, three of the people who are on shift are or will be eligible for retirement in the next year and it takes an average of six months for a new hire to be recruited.

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