Monday, April 25, 2011
Immunisation - what to do...
As the mum of three small boys I consider one of my greatest roles to be their advocate. This is particularly pertinent in medical decision-making. When Mitch and Harry were almost ready to leave the confines of the Neonatal Intensive Care Unit we were advised to have them immunised. In their case they were to be given smaller more frequent doses. Before agreeing to this I had time to think about the implications of vaccinations for my little men. To be honest the thought of injecting a foreign substance into their tiny bodies were pretty daunting. At this time Andrew Wakefield was extremely vocal with his belief that the MMR vaccine caused Autism in a small percentage of the population. And he had many passionate supporters. Here was a man who was stating that there was a definitive cause of Autism and it was caused by vaccinating your child. This raised a lot of questions for many parents...
Fortunately we did not need to make a decision about MMR at this stage (this is first given at 2 years of age in Australia), but it made me consider the other immunisations that were available. I only needed to look back a generation to get some answers. Both of my parents lived through the polio epidemics which swept through Australia from the 1930s until the 1960s. Over 40,000 people were affected with actual figures believed to be more than 100 times greater. My Dad recalled children leaving school and either returning with a lifelong disability or not at all, in fact Polio affected his family. Following the advent of the Salk, then Sabin Vaccines Poliomyelitis was eradicated from Australia in 2000. Several cases brought into Australia have not been able to spread due to the herd immunity in our country.
Other illnesses like Varicella (Chicken Pox), Pertussis (Whooping Cough) and Meningoccocal Type C are now either prevented or the effects greatly reduced by an immunisation program. All of which sounded to me like a very good reason to immunise my boys. BUT there were also the risks to consider and if my Google searches were to be believed then these were significant.
A quick online search revealed story after story of adverse reactions to immunisations. Countless organisations advocating the non-immunisation of children. Even books and TV shows discussing the decision to immunise. For a new parent it was very confusing. And in a lot of ways it continues to be so.
I focussed on the facts and figures regarding the benefits of immunisations, although it was often difficult to tease out the information and to establish if it was a verifiable source. Here is some of the information I obtained...
Diphtheria is an acute illness caused by the bacterium Corynebacterium diphtheriae. Toxins produced by the bacteria affect the respiratory tract, nervous system, adrenal gland and heart muscle cells. Diphtheria is spread by droplets or direct contact with wounds and materials soiled by infected persons. The disease can be fatal - between 5% and 10% of diphtheria patients die, even if properly treated. Untreated, the disease claims even more lives. In the early 1900s, diphtheria caused more deaths in Australia than any other infectious disease, but increasing use of diphtheria vaccines since World War II has led to its virtual disappearance. Perhaps, unsurprisngly Diptheria immunisation rates have fallen with an alarming case recently of a 22 year old Australia woman dying of Diptheria this year.
Pertussis (whooping cough) is caused by the bacterium Bordetella pertussis. The disease is highly infectious and most serious in babies. Babies are at greatest risk of infection until they can have at least two doses of the vaccine (minimum 4 months old) as the mother’s antibodies do not provide reliable protection. It is spread through droplets in the air and apnoea, seizures and encephalopathy may occur in very severe cases. Infants aged less than six months and adults often do not have the characteristic whoop. Paroxysms frequently end with the expulsion of clear, tenacious mucus. This is often followed by vomiting. Pneumonia is the most common cause of death. Fatal encephalopathy, which is probably hypoxic, and severe weakness from repeated vomiting, occasionally occur. The World Health Organization (WHO) estimates that in 2008, about 16 million cases of pertussis occurred worldwide, 95% of which were in developing countries, and that about 195 000 children died from the disease. Global immunisation programs were estimated to have averted about 687 000 deaths. Australia is currently experiencing a Whooping Cough epidemic and the concern is that with unprotected infants and a poorly immunised adult population the incidence of neonatal death will increase.
Tetanus (lock-jaw) is a disease caused by the bacteria Cilostridium tetani. Toxin made by the bacteria attacks a person's nervous system. Although the disease is fairly uncommon now, it can be fatal. Early symptoms of tetanus include - painful muscle spasms that begin in the jaw; stiff neck, shoulder and back muscles; difficulty swallowing; violent generalized muscle spasms; convulsions and breathing difficulties. Complications include pneumonia, broken bones (from the muscle spasms), respiratory failure and cardiac arrest. Few people in Australia get tetanus because of the protection given by immunisation but tetanus kills many hundreds of thousands of people world wide every year, many of them very young babies.
It is a difficult decision for many parents. There are so many opinions that it can be difficult to know which way to turn. For me the decision comes down to this - that since the advent of immunisation programs for a wide range of previously fatal diseases there has been a dramtatic drop in the incidences of these diseases. All immunisations have the potential for adverse reactions and we all need to be mindful of this, but the alternative can be far worse.
I am interested to hear what others think...