Fear Not The Shot

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Fear-Not-The-ShotFlu season is upon us once again. At the high school where I teach, my principal has been spraying the doorknobs with Lysol and reminding all of us to cough and sneeze into our elbows and frequently wash our hands. But my students and colleagues are still missing days, and all across the city New Yorkers are falling ill.

Communicable diseases have received a lot of attention this year because of the Ebola outbreak. With it, we experienced what our not-too-distant relatives and community members did when diseases like Haemophilus influenza, measles, polio, rubella, and pertussis (whooping cough) killed thousands of infants, children, and adults every year. But that was before vaccines against them were developed and widely administered. And unlike Ebola, the aforementioned diseases spread easily in the U.S., many through indirect contact.

Relatively few of us witnessed infants and children suffering the effects of, or dying from, polio, measles, and other now rarely spoken of diseases. And even fewer, if any, witnessed the devastation of the 1918-1919 Spanish Influenza pandemic that killed as many as fifty million people globally (hence “pandemic”). We now think of many of these as diseases of the past, as if we have destroyed the diseases themselves. In fact, they are alive and well, some are reemerging, and new ones are appearing. What has kept most of these diseases at bay is the success of our country’s vaccination campaigns. But that is, and has been, changing.  Influenza— though thought of as an uncomfortable inconvenience by many—is the third leading cause of death in New York City because of our low vaccination rates against it, according to a January 2014 New York City Department of Health and Mental Hygiene (NYCDOHMH) Epi Data Brief.

As a healthy thrity-five-year-old woman, I am at little risk of dying from the flu, but on Election Day last month I performed another civic duty in addition to voting: I got a flu shot. I did it to protect my friends’ infants and my students who may not have gotten the shot and cannot afford to miss school (and, honestly, because I’d rather not miss too many days of work).

A vaccine protects each individual who receives it, reducing or eliminating that person’s risk of contracting a disease; it can also protect those around them who have not received vaccines. An unvaccinated individual receives herd protection when a large enough percentage of individuals around her have been vaccinated because she is less likely to come into contact with an infected person.  Vaccinating ourselves and our children not only protects us, it protect the newborns, elderly, immunocompromised people, and others who are at greatest risk for suffering or death from infections and have not been able to get vaccines themselves. As Dr. Jay Varma, Deputy Commissioner, Disease Control, at the NYCDOHMH recently explained at an EcoHealth Alliance panel discussion, “the decisions you make about infectious diseases actually impact those around you.”

So why are so many people choosing not to vaccinate themselves and their children? According to Jeffrey P. Baker, MD, PhD in a report in the American Journal of Public Health, “fading memory of vaccine-preventable diseases, adverse media coverage, misinformation on the Internet, and litigation” have all contributed to parents’ fears that childhood vaccines may harm their children. This all leaves us with an abundance of confusing, and often inaccurate, information about vaccines and has led to the outbreak of many diseases we haven’t had to treat in the U.S. in many years.

Vaccines and the Autism Myth

One of the most popular pieces of misinformation being disseminated in the media and on the Internet is that of the connection between autism and childhood vaccinations. One of our most dangerous fallacies is believing that they do.

Autism was first labled as such by a psychoanalyst, Leo Kanner, in 1948. Early on, people believed that poor parenting caused autism. By the 1960s, a psychologist and father of a child with autism, Bernard Rimland, proposed that instead, it was biological. By the 1970s, investigators expanded the criteria for the diagnosis of autism and began to view it as a spectrum of disorders. In 1991 there was a significant increase in the diagnoses and early treatment of autism disorders because it was added to the “list of covered disabilities in the Individuals with Disabilities Education Act,” so researchers expected a rise, but not because there was a dramatic increase in cases. (This is one of the reasons people falsely believed that there was an autism epidemic in the 1990s.)

Then, in 1998, a British gastroenterologist, Andrew Wakefield, hypothesized that gastrointestinal issues were associated with autism and these were all caused by the measles-mumps-rubella (MMR) vaccine. Despite the fact that his hypothesis was based on a small number of patients, and despite the fact that no large-scale scientific study ever confirmed it, his “study” created the perfect storm for a wind of hysteria that would later have serious public health implications. By 2010 Britain’s General Medical Council determined that Wakefield had acted unethically in his study: He had carefully selected the twelve children, had performed invasive tests on them, and some of his research had been funded by lawyers who were acting on behalf of parents of children with autism who were suing vaccine manufacturers at that time. Despite this finding and a plethora of valid, reliable scientific studies that find no correlation between the MMR vaccine and autism, personal injury lawyers, concerned and well-intentioned parents, celebrities, et al. found “answers” they desperately wanted and helped popularize this dangerous myth.

Human Papilloma Virus (HPV) Vaccine

A different kind of fear has prevented many parents from vaccinating their tweens and teens when it comes to the Human Papilloma Virus, or HPV. There are more than forty types of HPV that are sexually transmitted, and two are high-risk types that are associated with 70 percent of cervical cancers. As of 2010, researchers concluded that up to 45 percent of women in their early twenties had already been infected with HPV. It’s so common, in fact, that by early adulthood many women and men have already been infected.

Due to its high prevalence and the risk HPV poses, particularly for females, the CDC has recommended that girls ages nine to twenty-six, particularly eleven to twelve-year-olds, receive an HPV vaccine. And in some states, it is one of the vaccines required for entry into public school. Many studies show that parents are in general very interested in vaccinating their daughters against HPV; however, vaccination rates have been relatively low in the U.S. So why the hesitation?

A concern expressed by some parents is a familiar one that arises regarding abstinence-only versus comprehensive sexual education in schools: the effects on their children’s behavior. Will our kids seek out sex because they are being confronted with issues regarding their sexuality, or will they behave recklessly because they falsely believe they are altogether protected?  This is absolutely something we can address both at home and in schools.

In New York City, we require our public middle and high schools to offer students specific sexual health education lessons during health courses. Having worked with teenagers for more than ten years, I understand the concern that  a vaccine protecting against an STI may give young adults a false sense of security. But I also know that as impulsive and reckless teens sometimes are, they are also concerned about themselves, their peers, their reputations, and their physical and emotional well-being.  Over the years I have had many students come to me in crisis after finding out they had contracted HPV. It’s understandably devastating for a teenager to find out she has an STI, but as STIs go, this one is so rampant it feels almost as common as a cold. The problem, of course, is that HPV can cause cervical cancer in addition to cancers of the vulva, vagina, penis, anus, and in the back of the throat.

According to the American Journal of Law and Medicine, we could “significantly reduce the enormous financial and human costs associated with cervical and other cancers” if the HPV vaccine were more “broadly accepted.” And once again, allaying our fears and turning to the facts could help achieve this.

Flu Vaccine Misconceptions

Over the past few years my highly educated, well-read, media savvy (and weary) friends in numerous professions (including education and health care) have given me various reasons that they didn’t get the flu shot: “I’m scared of the flu shot;” “I don’t want to get the flu, and I heard the vaccine can cause it;” “I’m afraid I’ll have a really bad reaction;” “Why would I get the flu shot? I can still get the flu even after getting the shot!” “I’m healthy, so I don’t need it.”

There are anecdotes and rumors…and then there is science.

The flu shot does not, in fact it cannot, cause the flu. Flu vaccines administered via needle are made with either an inactivated virus—meaning virus particles that have been killed and are non-infectious—or without flu viruses at all (in the case of the recombinant flu vaccines that were approved for the U.S. market in 2013). The nasal spray flu vaccine cannot cause the flu either. The nasal spray contains weakened flu viruses that are not able to infect warm areas of the body (like the lungs).

Why do some people still get the flu even after they’ve received the vaccine? People often self-diagnose with the flu, so they get it wrong. Rhinoviruses and other respiratory viruses are often going around during the flu season, and people believe they have the flu when they actually have something else. Alternatively,if you are exposed to influenza viruses right before you get vaccinated or within a couple weeks after, you are still vulnerable (it takes two weeks for your body to develop immune protection after receiving the vaccine). There are also many different flu viruses and you may be exposed to one that the vaccine does not protect against. In some situations, the flu vaccine does not always provide adequate protection; however, this is more  the case for people who are sixty-five and older or have weakened immune systems. If you are unfortunate enough to get the flu after receiving the flu vaccine, you are likely to have a milder illness than if you hadn’t been vaccinated.

Side effects from the flu shot and nasal spray vaccine are mild compared to the flu itself, and if you experience side effects they are likely to go away within a day or two.

Still, you’re thinking, you’re a healthy adult in a low-risk group, so why vaccinate? Remember, the decisions you make affect the people around you. Besides keeping yourself off the couch and burning through sick days, get the flu shot to protect pregnant women, infants, elderly, and people with chronic diseases and weakened immune systems from serious illness, hospitalizations, and death. And vaccinate your children who are six months old and older to keep them in school and out of the hospital. As many as 3,000 New Yorkers will die from the flu this year. And as few as 47 percent of adults in NYC will have received the flu vaccine. The flu is not something we need to resign ourselves to suffering from each year, and we certainly don’t want anyone literally dying from it.

For now, the greatest risks we face may be from the pandemics of panic and misinformation. Instead of being afraid that a vaccine will cause a disease or determine our children’s behavior, we should be embracing the fact that we have the vaccines available to protect us from what is actually threatening our health and well-being. We all play a part in preventing the reemergence and spread of communicable diseases. We can propagate fear and increase our risks for disease or we can side with science, which clearly shows us that vaccinating is the way to go. ◆

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