Examining the Anti-Vaccination Movement

Gary Podolsky MD

There are many people who do not believe in Immunization in Manitoba.

One may chose several reasons to reject a treatment such as immunization either for themselves or their children. In Manitoba it is legal for parents to opt their children out of the Public Vaccination program prior to entering school. Professional health colleges in Manitoba do require specific vaccines for entry, which are a reflection of the WRHA, National Advisory Committee on Immunization, Heath Canada, and CDC guidelines.

We live in a society that permits a plurality of views regarding religion, politics and other freedoms. It is important to preserve peoples right to make informed decisions regarding their health. But it is also important that they receive the correct information and are not over influenced from either the pharmacology industry or special interest groups with evidence that is not scientifically valid.

Anti-vaccinationists lobbyists rarely define themselves as "Anti-vaccinationists" as this has a distinct negative image. Instead titles such as "Concerned Parents for Immunizations" and the "Eagle Foundation" are used to connect themselves as a positive group seeking to disassemble a corrupt medical establishment. They present themselves as a group seeking balance but do not provide information that is in anyway provaccine so describing them as antivaccinationists is still true.

Public Health Groups have encountered this problem and tend to respond in one of two ways passively or aggressively.

Passive Approach

A passive approach is often taken, giving the critics of vaccines equal time in forums with the intention to not escalate confrontations (adding fuel to the fire). This approach is deeply flawed when it confers approval of unsubstantiated alternative health care philosophies and does not actual address gross inaccuracies in the attacks on vaccines.

At a recent public health exhibition on immunization in 2002 a forum was held, open to the public. The event was well publicized and speakers included Paediatricians, Victims of polio, and other Physicians from public health that spoke on a variety of issues all promoting vaccinations. Members of Winnipeg's Anti-immunization group arrived near the end and began distributing their own literature (theirs was free while parents would have to pay approximately $25 for the Health Canada Publication directed at parents) One prominent Chiropractor then made the claim that immunization with H Influenza clearly causes diabetes. He was allowed to continue making several erroneous attacks all unchallenged while all of the Public Health doctors stood by and allowed the parents in the audience to accept this. I spoke to one of the Health officers and she steadily maintained that everyone was entitled to their opinion even in the face of my protestations that Public Health had paid and organized the event to educate the public. A poll was taken at the end and less than half of the parents present claimed they would vaccinate their children based on what was said that day.

An active approach to antivaccinationism has been perceived by some as to brutal, a very characteristic arrogance of a medical elite dictating what people should have while this elite authority ignores mounting unsafety of immunizations. This perception is often true of medicine. Although an education campaign may be won in the short term (forcing meningitis vaccines on High School students) long term distrust of Public health may persist.

Over belief in medicine can also approach an irrational fanaticism similar to that of vaccine critics with both sides ignoring each other's evidence. By dismissing critics of immunization too quickly and ignoring that there are limitations to immunizations proponents of immunization programs may lose their arguments as well.

It is necessary to promote immunization in a positive way that is open to examination and critiscm especially since cost is an important consideration.

Several medical interventions including drugs and vaccines were previously thought to be very safe but later were withdrawn. If we depend too much on the integrity on any specific intervention we may be inevitably be let down such as in the recent case of Vioxx.

As Health Professionals and Consumers it is important to maintain a healthy level of critical thinking and be prepared to adjust our practices according to the best evidence available.

At present the best evidence is that most vaccines are a good idea. In the remainder of this talk I will emphasize key points about vaccinations I wish to communicate to other Health care Professionals and People in Manitoba.

For the remainder of this article I would like to avoid labelling any individuals as Anti-vaccinationists as this term is a broad classification that covers many heterogeneous individuals with a variety of beliefs regarding vaccines. Antivaccinationism as a philosophy or set of beliefs may be better dealt with than attacking a set of individuals with those beliefs.

People who have been misinformed or have an incomplete understanding of the science of immunization are good candidates to spend extra time explaining immunization with. By correcting misunderstanding these people may come to accept immunization on their own terms without being bullied or cajoled.

Debating Antivaccinationism

Antivaccinationism Activists who pursue an agenda against public health and the widespread use of immunizations are less likely to be reasoned with. Time should not be spent on debates where the rules and conduct are similar to brawls in the street. Debates with defined rules and equal time to both sides have been held between both groups with the provaccination group usually coming out ahead. In venues controlled by critics of immunization such as at Alternative Health Fairs debates are usually of poorer quality since a debater may be more easily shouted down or given ridiculous evidence they may not be able to refute or contest.

Clinicians focusing on educating the public and individual patients should focus on well-established facts on the benefits of immunization.

The limitations that vaccines have should be openly admitted and discussed. Side effects are infrequent and often only trivial but transparency in the surveillance and reporting of any perceived side effects must be maintained.

Immunization Questions continue after the vaccine is administered

Our clinic tends to insist on a face-to-face review of perceived vaccine side effects. This will reassure patients and has the added benefit of accurately diagnosing patients immediately.

One patient received Twinrix from us and had severe dizziness over the next several days. She had seen a medical doctor in follow up who did not examine her or give her a diagnosis or any type of treatment. In frustration she had seen her homeopathic physician who then told her she had multiple sclerosis caused by the vaccine and wanted to begin immediate homeopathic treatment. She began these but finally returned to us where I examined her with a very mundane Otitis media. She was prescribed antibiotics and I made sure she had a follow-up with me to ensure she had a full recovery .

Key Concepts in Promoting Immunizations

Immunization has saved Millions of Lives

Routine vaccines are safe

The eradication of diseases prevented by vaccines outweighs unconfirmed adverse reactions

Vaccine scares are common

Parental Concerns should be taken seriously

Health Professionals have a duty to provide accurate information to enable parents to make a truly informed decision regarding their Child's vaccinations.

The following pages go into great detail on many issues in current vaccinology.

Why Vaccines Work in Protecting Us: A Message To Parents and Clinicians

Compiled by Gary Podolsky MD

This article is intended to help both clinicians and parents learn the most up to date information on vaccines. Parents have to make important and sometimes difficult decisions for their children, and often the most difficult decisions are in regards to healthcare. There are several concerns in our community concerning vaccine safety without merit. The purpose of this talk is to correct misinformation. We all want to make the right choices regarding what is right for our children and protect the general public health as a community. A recent article in the British Medical Journal explained how all Healthcare workers and Teachers in Britain are always given new information on immunization practices, regardless of their actual role in immunizing children. This constant reinforcement of the need for immunizations helps them to be able to inform their patients to make informed decisions about their health.

We designed this booklet to meet the needs for information on behalf of Canadian parents, health care professionals, school nurses, childcare providers and others in order to:

1. Provide information about immunizations and vaccine-preventable diseases, in a similar format to information presented on car seats, bike helmets, and age appropriate toys.

2. Balance the benefits and risks of immunizations to assist you in making an informed decision.

3.Clarify inaccuracies or misinformation about vaccinations and vaccine-preventable diseases.

This booklet is arranged so that each section may be read independently. We have used a question and answer format. We hope that you will spread our messages about the importance of immunization with your patients. Information on immunization is rapidly changing so extensive links are included.

Immunization Saves Lives

Immunization is one of the most successful medical discoveries in human history and has saved millions of lives in the 20 th century. Many serious childhood diseases are preventable by using vaccines routinely recommended for children.

Since the start of these vaccinations, rates of disease such as polio, measles, mumps, rubella, diphtheria, pertussis (whooping cough) and meningitis from Haemophilus influenza B, have declined by 95-100 % . Before immunizations hundreds of thousands of children were affected each year with thousands dying each year (U.S. figures).

In under-immunized countries there are still 600,000 children dying each year from pertussis alone. Without routine vaccinations diseases we are now protected from will return. They will sicken and kill many infants and children while many survivors of severe illness will go on to have chronic health problems. Many countries are having problems because they stopped vaccinating against diseases that were felt to be under control. (The rebound incidence of diphtheria in the former U.SS.R. is a good example of this). It is only after a specific disease is no longer found in people and exists nowhere else (eg. soil, water or animals) that a vaccine can be safely discontinued. Smallpox vaccination lead to smallpox's official eradication and vaccinations were discontinued once this was certain.

Immunizations Prevent the Spread of Disease

Diseases spread through communities by infecting un-immunized people and the small percentage of people for whom immunizations do not work. For some highly contagious diseases like measles, even a small number of susceptibles can lead to outbreaks.

In 1989-1991 a measles outbreak occurred in the U.S. due to the failure to vaccinate preschool children on time. This epidemic was responsible for 55,000 cases of measles. At least 120 deaths occurred in children under age 5 months who had not been vaccinated.

In 1998, all of the measles cases in the US were cases that originated from other countries. With widespread globalization and travel to other countries, dangerous infectious diseases are only a plane ride away. By being well vaccinated as a population, we also increase our 'herd immunity' such that if an infectious agent does enter our population it will be blocked immediately from spread to others.

Immunizations are Safe

Immunizations are extremely safe and getting safer and more effective due to ongoing research. Immunizations are given to keep healthy people well. They are held to the highest safety standards. The number of vaccinations available keeps expanding as more and more diseases are being studied.

Immunizations Save Money

Every dollar spent on vaccinations saves seven dollars in medical costs and 25 dollars in overall costs (i.e. missed work). Complications from hepatitis B related liver diseases exceed 500 million dollars U.S. (U.S. figures). This total cost includes direct (medical costs) and indirect (lost work) but doesn't include human suffering.

Immunizations are Strong Protection

Immunization is the single most important way parents can protect their children against serious disease. Children who are not immunized are at a far greater chance of becoming infected with severe disease.

Immunizations work naturally by using the body's immune system and make it stronger and more effective at fighting disease. There are no other effective alternative ways to prevent many of these diseases. Breastfeeding is helpful in preventing some diseases among babies but is not effective against preventing all serious diseases.

Other Important Facts:

Infants are often affected more severely than older children by the same diseases. Their immune systems are weaker and cannot fight off bacteria or viruses as well.

Even if a disease is not currently reported in a region the bacteria or viruses may still be present. Disease outbreaks are prevented by routine vaccinations.

Most vaccines are provided free through Manitoba Health.

Many are covered in other jurisdictions but not Manitoba. In Manitoba, Hepatitis B is covered for grade 4 children only. Varicella (chicken pox), meningitis and pneumococcal pneumonia are now covered by Manitoba Health for children born in 2004 . Immunizations such as Hepatitis A are not covered in Manitoba.

How the Immune System Works

The immune system is the body's defense system against disease. Medical research has developed vaccines to help the immune system fight disease. When you get an infection the body produces antibodies. Antibodies will attack antigens ( invading bacteria or viruses ) and help fight illness. Antibodies will stay in the body after the original disease is gone to protect you from getting that disease again. This memory of the immune system is called immunity.

Mother's milk confers immunity temporarily as antibodies in the mother's milk are passed on to protect the infant. These antibodies wane with time leaving no memory or lasting immunity. Therefore infants need to be vaccinated in order to develop their own immunity. In making a vaccine against a bacteria or virus, the infectious agent is weakened so that the vaccine does not cause illness. The body is tricked into responding to the antigens of a vaccine so that the specific immunity it develops will be effective against real bacteria or viruses.

Vaccines are available in different types. Live vaccines are made from weakened (attenuated) viruses or bacteria. Live vaccines are extremely effective and produce lifelong immunity after only 1 or 2 doses.

Inactivated vaccines are dead viruses and require multiple doses to buildup a good immune response. Some inactivated vaccines require boosters throughout life (like tetanus-diphtheria which is repeated every 10 years).

Questions and Answers

Question: Do vaccines really work?

Answer: Yes. Everywhere where vaccination occurs, diseases have declined in incidence.

Question: Why do some children still get measles after vaccination?

Answer: We know that one dose of measles does not protect 100% of people immunized and that 5-10% will still be susceptible to a measles infection. That is why a second shot is later given. There are always small amounts of people who may not respond well to vaccines and are not immune. If they get ill they usually are still protected by the vaccine from developing full-blown disease.

Question: Isn't catching a natural infection such as wild measles, better than an artificial immunization from a vaccine in giving immunity?

Answer : No. In neither case are infections or vaccines natural. A 'natural infection' with an agent like measles, will also carry the risk of disease. The vaccine is intended to stimulate the immune system without getting the disease. Vaccines are made to optimize immune function. Some diseases such as tetanus do not even induce immunity after an infection, while others may (Hepatitis A infection survivors will have lifelong immunity). It is also unnatural to have a child's spine manipulated, adjusted, or jostled, which will not affect the immune system .

Question: Doesn't immunity wear off after time?

Answer: Yes. Different vaccines give different immune responses after the proper schedule is carried out. Some like tetanus and diptheria, need to be boosted every 10 years for adults while others like measles, will require no further boosters.

Question: Can vaccines cause seizures?

Answer: Indirectly yes. Vaccines can cause a fever that may then cause convulsions in some children (3% of otherwise healthy children) but these seizures are not a sign of brain injury. Several large studies have looked at febrile (fever associated) seizures and found that there is no evidence of brain damage from any vaccine. If a child has a fever it is recommended that the child take an antifever medication such as children's Tylenol.

Question: Can vaccines cause cancer?

Answer No. There is no evidence of this. There is strong evidence that the Hepatitis B vaccine will prevent cancer. The BCG vaccine is actually used to treat bladder cancer.

Question: Are the preservatives in vaccines (Formaldehyde, Aluminum, Mercury, Thimersol) toxic?

Answer: The amount of chemicals used as preservatives in vaccines is very minute and non-toxic, even for infants. These preservatives are reviewed by Health Canada and felt to be safe. Some vaccines do contain antibiotics or egg products, which should not be used if a history of allergies exists. Regarding eggs, if a child is able to eat an egg without difficulty then the vaccine may be given. Manufacturers of vaccines plan to substitute thimersol in their products not because of any health concerns, but to avoid further controversy. There is still no good evidence that thimersol in vaccines causes problems.

Question: Does any vaccine contain brain tissue, which transmit Mad Cow Disease?

Answer: No.

Question: Why do Chiropractors, Homeopaths, and Naturopaths, advise against immunization?

Answer: The Policy of the Faculty of Homeopathy at the London Royal Homeopathic Hospital is: "Where there is no medical contraindication, immunization should be carried out in the normal manner, using conventionally tested and approved vaccines". The Manitoba Chiropractors Association has also formally stated that they approve of vaccinations. Despite these statements from official organizations, many alternative "practitioners" strongly oppose vaccination.

Anti-vaccinationists have been around for a long time, and may use false claims for any number of reasons but they do this without any support from their governing bodies and are hence are themselves "denatured". Many early vaccines had well documented severe adverse effects but modern vaccines should not be confused with these. Anyone may state an opinion, but using a professional title to advocate a view that cannot be scientifically supported, is wrong.

Question: Do vaccines alter or weaken the immune systems own natural ability to fight off disease?

Answer: No, a vaccine only evokes an immune response specific to a specific group of antigens. For example, the vaccine for polio will have no effect on the body's ability to handle hepatitis B since each infectious agent is recognized differently. This is why it is important to be vaccinated against all the diseases available.

Question: Does breastfeeding replace the need for vaccination?

Answer: Although breast fed babies receive antibodies in mothers milk that protect them in their early years, they are not protected from all diseases. Vaccines give specific and long lasting protection.

Question: Does giving more than one vaccine on the same day 'overload' the immune system? Would it not be better to give only one vaccine at a time?

Answer: No. Receiving more than 1 vaccine at a time does not harm a child's body. Vaccines only use a tiny part of the body's immune system. Many childhood vaccinations are given at the same time for convenience because this ensures that the child doe not miss important dates and also means fewer needles.

As a person eats and breathes, their immune system is constantly exposed to many infectious agents. Vaccines represent a small fraction of the antigens a person is regularly exposed to.

Question: Is the method of injection of vaccines harmful?

Answer: No. Injecting vaccines is a safe method and has been used for decades.

Vaccines are never injected into the bloodstream. Most are injected either into the muscle or into the fat just beneath the skin. Each needle and syringe is disposed of after use as they are only used once.

Question: Can someone get a disease that they had been vaccinated against?

Answer: Yes, modern vaccines are extremely effective but are still not perfect. If a vaccine is 90 % effective then 10 % of people will not develop sufficient antibodies to prevent disease. If an infection rolls into town the susceptible individuals (all of the un-vaccinated and 10 % of those vaccinated) are likely to become infected. Those 10 % may still have partial immunity in that they will experience a milder form of disease.

If a community is well vaccinated, diseases will be harder to catch since person- to person contact is blocked. This 'herd immunity' protects those susceptible individuals.

Many vaccines also require more than 1 dose to be effective. Some antibodies ( such as tetanus ) will wane with time and require future booster shots.

Question: I have heard that the real reason that these vaccine-preventable diseases began to disappear was because of better hygiene and sanitation and not because of vaccines. Is this true?

Answer: No. Many infectious diseases did become better controlled with better public health improvements but they remained serious threats due to periodic outbreaks in susceptible populations. It wasn't until vaccines were introduced that the actual rates of incidence went down dramatically.

But fighting diseases involves many issues. Vaccines have definitely been assisted by other factors such as:

•  Better nutrition

•  Less crowded living conditions with better sanitation

•  More effective treatments such as antibiotics

But in spite of these improvements, vaccine-preventable diseases still occur due to lack of vaccination.

A good example of the effect of a vaccine after its introduction occurred with the Hib vaccine. In 1984 when it was first introduced in Washington State there were 80 cases of Haemophilus per year. Rates steadily decreased in the next 2-7 years to essentially 0 cases by 1998. Sanitation did not change much during this time. The Hib vaccine was the only new variable.

Similarly in 1963 there were 500,000 measles cases (with 500 deaths that year) in the U.S. In 1998 there were 100 cases reported with no deaths.

Question: Isn't it still better to become immune from natural sources rather than through a vaccine?

Answer: No. Vaccine preventable diseases can still be lethal, or cause permanent damage (brain damage from measles or pertussis, liver cancer (from hepatitis B), or paralysis (from polio). Some vaccines such as tetanus are even better at creating immunity than the natural infection.

Vaccines prevent disease without risking an adverse effect from an infection. A good example is chicken pox. Chicken pox in an adult can be a very serious illness whereas most children only become mild to moderately ill. Previously before immunizations were available, parents were encouraged to have their children deliberately exposed to other children with chickenpox ( "chicken pox parties" ), so that their child would receive lifelong immunity. This was a rational approach at that time, since the risk to that child later in life as an adult could be life threatening if they missed their being infected as a child. We no longer advocate chicken pox parties because the varicella vaccine uses a live attenuated virus to prevent chicken pox illness in children without the associated risks of disease.

Vaccinating Children-To Wait or Not

Parents frequently wonder why vaccines are given to children so early in life. They may ask to wait until their child is about to enter school before getting immunized.

Question: Is it all right to wait until school starts to get immunized?

Answer: No, waiting too long may put your daughter or son at an unnecessary risk of contracting serious disease. Maternal antibodies fade during the first year of life. This also occurs when children are more frequently exposed to other children and adults. Many of the vaccine -preventable diseases are more severe in very young children.

For example, the peak vulnerability of children for Haemophilus disease is at ages 6-7 months, therefore for the vaccine to be most effective it should be given before this time.

In a measles epidemic in the U.S. (1990) 40 % the of cases were in children less than 4 years old. Most of these could have received their measle vaccinations at 15 months but did not. Now children get their measle vaccinations as early as 12 months of age (and 6 months during outbreaks).

Question: Can my child catch up if they missed or are behind on vaccines?

Answer: Yes, but it is best to stay close to the recommended schedule. An interruption in the schedule does not mean having to restart the series. Until the vaccine series is finished, the child will not have maximum protection against the disease. If the child's immunization schedule is behind parents should speak with their family doctor, immunization nurse or public heath clinic.

If a child is going to live overseas regular vaccinations may be given earlier to adjust for the increased risk of some diseases in certain countries. If planning an oversees trip consult a Travel Medicine Clinic for appropriate advice.

Question: Are immunizations safe even If my child has a minor illness?

Answer: Yes, immunizations may be given even if your child has a mild illness such as a mild fever, cold, diarrhea, or is taking antibiotics. The vaccine will still be effective since your immune system is always working and the vaccines do not overload it or prevent it from working against other illnesses.

Vaccines will not make other illnesses worse. Receiving immunizations on time is a way of cutting down on unnecessary doctor's visits.  

Question : But are there some instances when vaccines should not be given?

Answer : Yes, there are some medical reasons for not giving or for delaying vaccines. These instances are uncommon but should be followed. Generally a person should not receive a vaccine if they have significant allergy to one of its components. Components like neomycin or gelatin are added to some vaccines, and should be avoided in individuals sensitive to them.

Another example is the yellow fever vaccine, which is prepared with egg products and should not be taken by individuals allergic to eggs. If a person can eat one egg without vomiting or being sick then they may have this vaccine. The yellow fever vaccine is given only to international travelers going to South and Central America or Africa and is NOT routinely given to children.

Children with medical conditions, whose treatments or medications could reduce the effectiveness of the vaccines, may delay receiving vaccinations until they have finished their treatment. Examples include: receiving recent blood products ( immunoglobulin or blood transfusion ) and high dose corticosteroids both of which may impair the immune systems ability to respond to the vaccine. These children may not respond as well to some vaccines but they are also more susceptible to infections.

Very sick individuals (cancer patients, HIV positive people and those with other illnesses affecting immunity) should still receive vaccinations. Some people with impaired immune systems or immunosuppression treatments may not respond as well to vaccines, and may require additional booster doses. Families should speak with their family physician or specialist to determine how to proceed with vaccination or delay.

In most cases vaccines may be given if the child is breastfed, has an ear infection, is taking antibiotics, has mild diarrhea, or has a milk allergy. Check with a health case provider who administers vaccinations if you have specific questions.

There is no need to delay vaccinations for : minor cough, colds or diarrhea; high fever 40°C after a previous vaccine dose; prolonged tiredness after a previous vaccine dose; local skin reactions after vaccine; history of convulsions with or without fever; active allergy; allergy to eggs; being on current antibiotics; being born prematurely; those with family history of Sudden Infant death Syndrome (SIDS); infants breastfeeding (both mother or child can get vaccine); or a child's mother is pregnant.

Vaccine Preventable Diseases

According to the World Health Organization (W.H.O), immunization programs save 3 million lives per year.

The following are diseases that we can prevent through vaccination.

Research is so that immunizations for other infectious diseases will be added to this list.

Diptheria, Tetanus, and Pertussis

Diptheria is easily spread through coughing or sneezing and can cause paralysis, breathing and heart problems, and death. Recent outbreaks have occurred in the former U.S.S.R, which had temporarily abandoned diphtheria vaccinations, which has made a large segment of their population vulnerable. Prior to vaccination in the 1920's, there were 12,000 cases per year with 1,000 deaths per year in Canada. Diptheria still kills 1 in 10 of those infected.

Tetanus (lock jaw) occurs when a tetanus germ enters a cut or wound and can cause muscle spasms, breathing and heart problems, and death. The tetanus bacteria are found in soil and are everywhere. A booster is recommended every 10 years. Before vaccination, about 5000 cases per year occurred in the U.S. Even with modern treatment 10-20% of these infected will die.

Pertussis (whooping cough) is spread through coughing or sneezing and can cause long spells of coughing actually making it difficult to eat, drink or even breathe. Pertussis can cause lung problems, seizures, brain damage and death, especially in infants less than 1 year old. Before vaccination 5 out of 1000 children died of pertussis before age 5. Hygiene improvements as well as vaccination have decreased this statistic. Pertussis still kills 3 children per year in Canada.

Question: What is the difference between "whole - cell DTP and the new acellular DTaP?"

Answer: The new vaccines ( available since 1997) are known as acellular or non-cellular. They contain only the antigens necessary to give immunity and not the "whole cell". The older "whole cell" Pertussis vaccine contained the whole killed Pertussis bacteria, which lead to a higher rate of local reactions like redness, swelling, and pain at the injection site, and a fever also.

Health authorities now recommend that all Pertussis vaccines be acellular as this higher generation of vaccine has much less local effects.

Question: So what are the effects of the DTaP vaccine?

Answer: Most children receiving the DtaP will have no adverse reactions or experience only minor discomfort. The most common reactions are soreness, swelling, and redness at the injection site usually after the 4 th and 5 th DtaP. They last 1-2 days. Serious adverse reactions are rarely reported with the acellular Pertussis.

Question: How effective is DTaP and is it worth receiving?

Answer: A full series of 4 DTaP by 18 years of age is recommended to get full immunity. A full series protects 80 out of 100 children from getting severe Pertussis, 95 out of 100 from Diphtheria, and 100 % are protected from tetanus. In the 20 % of those vaccinated who do develop Pertussis they will have a milder form of the illness.

Small children and infants who catch Pertussis are often critically ill. Insufficient immunization in a community contributes to a higher rate of Pertussis there.

Most people vaccinated with DTaP are protected for many years. Adults are recommended to have TD ( Tetanus-Diphtheria ) shots every 10 years to boost themselves.

Because it is so contagious the possibility of a child getting severe Pertussis when exposed is far greater than the possibility of experiencing a severe adverse reaction from the vaccine.

Haemophilis Influenza Type B (Hib)

Hib bacteria can cause meningitis ( inflammation of the brain ) infections of the joints, skin and blood, brain damage and death. It is most serious in infants less than 1 year. Since vaccinations for this disease began, incidence of this disease has dramatically declined. Before 1985, about 1500 cases of meningitis from Hib occurred per year. Vaccination has dramatically decreased the incidence of severe Hib infection.

Hepatitis A-

Hepatitis A is a virus that causes infection of the liver. It can be passed from mother to child during birth, through blood or body fluids, and poor hygiene in food and water. Infected people can transmit it to others in the same household through casual contact. Symptoms include diarrhea, jaundice, hepatitis and death. Adults and elderly people are more severely affected. After exposure the average incubation time is 15-50 days ( average 28 days ). Illness does not usually last longer than 8 weeks although about 10-20 % of those affected could have symptoms for 6 months.

Question: If Hepatitis A is most commonly transmitted by contact with the stool of infected people, why should we get vaccinated if we keep clean?

Answer: Cleanliness such as hand washing after using the washroom or changing diapers is essential for hygiene but still not 100 % effective.

People who are infected with hepatitis A often transmit the virus for 1-2 weeks before they feel sick. Children will less often show signs of infections in Canada and U.S. mostly due to improvements in hygiene. New cases are acquired through people visiting other countries and bringing the infection home. Routine Hepatitis A vaccination of children is currently not strongly recommended. Parents planning trips to underdeveloped countries may consider Hepatitis A for themselves and their children. Cruise ship holidays would be included as well.

Hepatitis B - is a different viral infection of the liver. It is transmitted through blood and bodily fluids and intimate contact. It is more common, easier to catch and kills more people than AIDS annually. Infection may cause liver damage, liver cancer and death. It is the second most common cause of human cancer. The incubation period of Hepatitis B can be 45-60 days ( average 120 days ). Initially the preictal phase consists of malaise, anorexia, nausea, abdominal pain, fever, headache, arthritis, and dark urine. This usually lasts 3-10 days. Next the jaundice or ictal phase occurs and lasts 1-3 weeks. Jaundice, light or gray stools, liver tenderness or enlargement characterize it. Next convalescence occurs for weeks or months with persistent malaise and fatigue. Most people with Hepatitis B infections recover with immunity and clearance of the virus from the body but some do not. Fulminate hepatitis occurs in 1-2 % . This liver failure can be severe with mortality ranging from 63-93 % . Another 10 % of cases go on to develop chronic hepatitis B infection. These people may not be symptomatic but they can infect others. They are also prone to fulminant hepatitis, liver failure cirrhosis, and especially liver cancer.

Question: Why are we vaccinating children against Hepatitis B since most of the people getting Hepatitis B are adults?

Answer: National recommendations for both Canada and the U.SA. recommend routine vaccinations of all children against Hepatitis B because it is impossible to predict who will be exposed to Hepatitis B in the future. Hepatitis B is acquired through blood routes ( IV drugs, unprotected sex, non-sterile medical procedures, unscreened blood, and any body fluid-non intact skin or mucous membrane contact ) all of which are unlikely for children but 30 % of Hepatitis B cases are unknown in how they got the disease.

Most of these cases are believed to have occurred from being bitten or scratched, from sharing a utensil, or having some type of close contact with a playmate or family member. The earlier in life a child acquires Hepatitis B the more likely they are of becoming a chronic carrier. In the U.S. Hep B is given to infants while in Manitoba it is given at grade 4 (which is more for administrative purposes rather than a decreased increased risk between U.S. and Manitoba).

In the U.S Hep B infects 200,000 people per year, with many being adolescents or young adults. As yet there is no specific treatment for acute Hepatitis B. The virus may cause liver damage, liver cancer, and death.

In the U.S. 1.25 million people are infected. The Hepatitis B virus is more common than, easier to transmit, and kills more people than the HIV virus causing AIDS, yet is vaccine preventable.

People at high risk for Hepatitis B, are recommended to be vaccinated.

Recommending vaccination to high-risk individuals has not been effective in decreasing the incidence of Hepatitis B, since many people at risk for infection do not fit into the stereotype of a high-risk person (promiscuous or drug users), universal vaccination is now recommended or children.

Question: Does Hepatitis B vaccination cause Multiple Sclerosis (MS) or Sudden Infant Death Syndrome (SIDS) or Autism?

Answer: No. Multiple Sclerosis is an autoimmune disease where antibodies attack the bodies own myelin in the nerves causing many types of neurological problems that may stay stable or get worse throughout life. The cause of MS is still unknown but medical experts believe that certain patients are genetically at risk for the disease and that some environmental factors can trigger the disease.

There is no evidence that vaccination with Hepatitis B can cause MS or be one of the triggers. One French study analysed over 60 million people hepatitis B immunizations given between 1989-1997 and found that people vaccinated against Hepatitis B were less likely to have neurological disease than unvaccinated people.

A recent study in the New England Journal of Medicine also confirms this. The Multiple Sclerosis Society supports the wide and general use of this vaccine. There is some evidence that people vaccinated against Hepatitis B may be less likely to get MS.

Sudden Infant Death Syndrome (SIDS) is the name for increased mortality in apparently healthy infants. Investigators are continuing to find all of the possible causes for this syndrome including the observation that sleeping on the stomach may increase this.

In the U.S., infants receive Hepatitis B immunizations starting as early as the first day of life (since 1991). There has been a steady decrease in the number of newborn deaths as the number of Hepatitis B vaccines administered has increased.

The American Institute of Medicine has reported: "All controlled studies that have compared immunized versus non-immunized children have found no association or decreased risk of SIDS among vaccinated children." To learn more about SIDS please check with your pediatrician or obstetrician or check the references at the back of this booklet.

Autism - There is no evidence to suggest that Autism is related to Hepatitis B vaccines. See the section on Measles, Mumps, and Rubella for more information on Autism.

Question: Isn't the preservative in Hepatitis B (Thimersol) related to mercury and could my child get mercury poisoning from the Hepatitis B vaccine?

Answer : There is Thimersol in some Hepatitis B vaccines. Some manufacturers are now using other preservatives instead. It is still felt that the amounts of Thimersol in each dose of Hepatitis B vaccine are insignificant to cause problems.

The Hepatitis B vaccine has been scrutinized carefully before being approved in Canada, the U.S, and abroad and is felt to be safe for use.

Polio

One hundred years ago, Polio infection was one of the major crippling diseases. The last epidemic in Canada involved 2,000 cases of paralytic Polio (1959). Polio infection can cause fever and may lead to meningitis and lifelong paralysis. Persons infected with poliovirus shed the virus in the stool and spread it to others. With ongoing immunizations the World Health Organization's ( W.H.O .) goal date of eradication is 2005. Sometime thereafter if no new polio cases are reported worldwide, immunization will discontinue, possibly by 2007.

Question: Isn't the Poliovirus supposed to be extinct?

Answer: No, not yet. The World Health Organization originally had set out to destroy it by 2000 but recent outbreaks of confirmed Polio cases in Africa and India, have confirmed it is still active. This failure was partly due to a failure to fully vaccinate children in developing countries.

Polio vaccination is still recommended for international travelers going to those countries. Polio vaccination must continue until confirmation of no known cases of the wild type has occurred. It is only spread among people so as soon as the last person is infected or immunized then it will be extinct.

It is still recommended to continue with routine childhood Polio vaccinations because if a susceptible person were to bring a Polio infection back to North America it could precipitate an outbreak among those who are not immune to polio. Efforts are being made overseas to vaccinate countries that have not had up to date Polio vaccinations with the new goal date of eradication being 2005. It is likely that vaccination will continue for some time after that and then stopped, as was the case with Small Pox eradication.

The Polio vaccine used in North America is the IPV or Inactivated Polio Virus, which has no significant side effects. The OPV or Oral Polio Vaccine is no longer used since this was known to have side effects including vaccine induced Polio ( 1 in 2.5 million chance) It was still recommended at that time despite its very rare side effects, it still saved lives and helped make polio disappear from North America). There is no good reason to use the OPV in Canada now, with the safer profile of the IPV.

Influenza

Influenza - (which is a different disease from the similarly named Haemophilis Influenza type B mentioned above) is a highly contagious viral disease with epidemics regularly occurring. Infection causes sudden onset of fever, chills, muscle aches, cough, headache, and may lead to pneumonia. Sneezing, coughing, or direct contact spreads it with the infected person. Children and adults with long-term illnesses such as asthma and diabetes are more prone to serious flu complications such as pneumonia, dehydration, meningitis, and even death. Influenza infection is a major cause of death in the elderly.

The virus has 3 subtypes A, B , and C . Type A causes moderate to severe disease, affects only humans and affects all age groups. Type B causes mild disease and affects only humans, mostly children. Type C affects animals and rarely humans and is not associated with epidemics. The influenza virus also mutates frequently. Antigenic shifts and drifts are major and minor changes in the antigens (or parts of the virus recognized by the body's immune system).

These changes allow the virus to persist in the population and give rise to epidemics of the flu. Epidemics occur when the incidence of influenza cases increase and mortality rises. Pandemics occur with high incidence in all age groups and increased mortality. An influenza pandemic could affect up to 200 million people with an estimated 400,000 deaths. Sporadic outbreaks occur when clusters of cases occur in families, schools or small communities.

The virus is acquired from respiratory droplets. It replicates in the trachea and bronchi causing local destruction and is shed for 5-10 days. Maximal communicatability occurs 1-2 days before onset and 4-5 days after. Symptoms appear after an incubation of 1-2 days. Abrupt onset of fever, muscle aches, non-productive coughs, and headaches occur. Severity is less if the person has encountered a similar antigened virus before. Only 50 % of people have the above classical symptoms of influenza. Symptoms last 2-3 days and rarely more than 5. Aspirin should not be taken by children with flu, because of the association with Reye's syndrome, an often-fatal affliction.

Complications that occur with the flu include pneumonia (either a bacterial super infection on top of the influenza or an influenza pneumonia which is rarer). Reye's syndrome is a rare complication in children with the development of coma and some types of brain swelling. Other complications include myocarditis ( heart inflammation ), and worsening of chronic bronchitis. Death occurs in 0.5-1 cases per 1000 cases, usually in those ages greater than 65 years.

Diagnosing influenza can be difficult and is largely based on clinical appearance along with the influenza prevalence in the community. Influenza peaks between December and March in temperate climates but can vary. It is year long in the tropics and outbreaks are common aboard cruise ships.

Vaccination against influenza - is done with an inactivated virus of circulating strains of type A and B influenza. Egg protein is present. The vaccine is effective in protecting 70% of healthy adults but only 30-40% of the elderly. It is not highly effective in preventing illness but is effective in preventing complications and death particularly in the elderly. The vaccine is most effective if given 2-4 months prior to flu exposure and is usually available in September. The vaccine may be given annually. Children from 6 months to 9 years receiving it for the first time should receive 2 doses 1 month apart. (Ideally the second dose should be before the end of November).

Flu shots are recommended for all people over 50 (those over 65 are covered by Manitoba Health), children > 6 months with chronic disease, long term care residents, health care workers, students, travelers, pregnant women, and persons 6 months to 18 years taking chronic aspirin therapy (so that they do not develop Reye's Syndrome). Any person who wishes to decrease the likelihood of becoming ill from influenza should receive the flu shot although Manitoba Health does not cover all the above groups. With a possible pandemic this recommendation may change.

Vaccine Safety

Parents have concerns about vaccine safety. In licensing vaccines, Health Canada and the U.S Food and Drug Administration have developed scientific criteria for approving vaccines and monitoring side effects once approval has been given.

Approval of Vaccines

The approval process for vaccines is regulated and involves clinical trials in three phases.

After completing the three phases, the manufacturer submits the data on safety and effectiveness to Health Canada or to the FDA in an application for license to sell the product. Health Canada has the responsibility to review the clinical studies data, the available facilities, and the methods used for manufacturing the product. On average it may take over 5 years from the time of application for licensing to occur. Approval does not occur until the safety and effectiveness of the product is assured.

Monitoring Vaccine Safety

After a product is approved vaccine safety is monitored by a variety of ways including on site inspection of the manufacturing facility. A review of the manufacturer's testing of the vaccine is done for safety, purity, and potency. Health Canada and the FDA may repeat some of these tests themselves.

There is also a national system in Canada and in the United States to report any possible adverse effects reported by health care providers, patients, parents or anyone with a concern of a possible adverse effect after receiving a vaccine. Health care providers and vaccine manufacturers are required by law to report serious adverse events.

Question: Are there certain vaccine lots that have more adverse effects?

Answer: No, to date no vaccine lots in the modern era have been found to be unsafe. The vaccine reporting system monitors vaccine lots. Occasionally people have misinterpreted data leading to unsubstantiated media reports about "unsafe lots" of vaccines.

All reports of adverse effects are accepted. Larger lots of vaccines (1 million doses) are more likely to receive more reports of adverse effects than smaller lots (10 thousand doses). The fact that there are more reports for a particular lot does not mean that the lot was unsafe or that the vaccine caused the event.

If a lot has a number of reports leading it to be believed to be possibly unsafe, it will immediately be recalled. There is no benefit to either the manufacturer or to Health Canada to allow an unsafe vaccine on the market.

Question: Do vaccines cause chronic diseases such as Diabetes, Crohn's disease, and Cancer?

Answer : After decades of vaccine use there is no evidence that vaccines cause chronic illnesses. Many people are concerned that autoimmune diseases have been "triggered" by immunizations but the immune system does not work that way. Vaccine safety research is continuing to investigate theories linking vaccination with chronic diseases to assure that the public is receiving safe vaccines.

Researchers have published articles about their theories suggesting vaccines cause chronic illnesses, but when other researchers attempt to duplicate these studies, they cannot. Medical conclusions about vaccine safety and the cause of disease must be based on the quality of the medical research. Because no vaccine is without risk, when medical and public health workers recommend vaccines they must balance the scientific evidence of risk, and benefit from the vaccine with the cost of producing it. This balance changes as diseases are eliminated. One example is that with the eradication of small pox, the risk of adverse effects from the small pox vaccine far outweighs any benefit from receiving the vaccine, so it was discontinued from regular use.

Question: How do we know that vaccination adverse effect reporting works?

Answer: The reporting system is an effective system for monitoring vaccine safety. An example is the rotavirus vaccine, which became available in 1999 but is not presently used. Rotavirus is a common cause of severe diarrhea in infants and children. After the vaccine was released in the U.S.A, reports of bowel obstruction among infants who received this vaccine increased. Even though there were not enough reports to establish a relationship.

The Center for Disease Control (CDC) recommended further evaluation. At present it is not used.