The vaccine dilemma

By Petro-Anne Vlok
08 July 2016

With so many conflicting medical opinions, how are parents to decide whether to vaccinate their child? We look at the myths and the facts.

A Canadian dad was recently jailed for failing to provide the “necessities of life” to his son, who died of meningitis – because his parents didn’t believe in vaccinating their kids.

See this week’s YOU for the story. Meanwhile, read this… 

TO VACCINATE or not to vaccinate? That’s the question many parents of young children are asking these days.

It used to be simple: the jabs were administered free of charge at clinics to protect children against potentially fatal diseases such as measles and polio.

But then a study was published in the late ’90s linking one particular vaccine to the onset of autism in children and all hell broke loose. Suddenly many parents became reluctant to have their kids vaccinated. And even though the controversial study was debunked in 2010, many continue to avoid having their children immunised.

Which is why we’re now seeing more cases of diseases such as measles, experts say.

During the last big outbreak of measles in 2009 to 2011 there were 18 431 confirmed cases of the disease in South Africa with

infants and children younger than four being the worst affected.

There were 18 deaths among the 552 cases treated at Cape Town’s Red Cross War Memorial Children’s Hospital.

Read more: We asked YOU Supermoms if they vaccinated there children. Here's what they said.

While most people who contract measles recover in a few weeks the disease can pose a serious risk for malnourished children or very young kids with weak immune systems, leading to a host of serious complications including blindness, encephalitis, severe diarrhoea, ear infection and pneumonia.

In developing countries measles claims the lives hundreds of thousands of children annually.

The anti-vaccination trend in SA isn’t as widespread as it is in the US and the UK, says Lee Baker, a pharmacist and manager at Amayeza Information Centre in Johannesburg, which runs a vaccination helpline. However doctors in private practice and clinics say they do encounter small groups of people who refuse to have their children vaccinated.

While immunisation isn’t a legal requirement, parents can be asked to supply a proof of immunisation when enrolling their kids at school.

It used to be that parents vaccinated their children, no questions asked, so how did the anti-vaccination trend come about? Some medical experts believe vaccinations became victims of their own success.

People have forgotten just how devastating vaccine-preventable diseases are, says Professor Helen Rees, chairperson of the World Health Organisation’s (WHO) African Task Force on Immunisation.

“People used to be afraid of diseases such as polio and measles. Now people don’t see polio anymore and think, ‘Why should I immunise?’” Dr Gert van Zyl of the University of Stellenbosch’s division of medical virology agrees. “We no longer see family members or friends suffering from these diseases. The fear of these diseases has waned in the popular culture,” he says. “There’s also a lot of disinformation and belief that certain ‘natural’ alternative healthcare approaches are safer. Conspiracy theories have done a lot of harm,” he adds.

We take a look at myths and misconceptions surrounding vaccinations:

The MMR vaccine causes autism

Many people trace the origins of the anti-vaccination movement to the now debunked study by British surgeon and medical

researcher Andrew Wakefield. Published in the medical journal The Lancet in 1998, it claimed a link between the administration of the Measles,  Mumps and Rubella vaccine (MMR) and the onset of autism and bowel disease.

However in 2010 the General Medical Council ruled that Wakefield based his evidence on falsified information, acted  unethically and received money from lawyers seeking evidence against vaccine manufacturers.

He was struck off the medical register and The Lancet retracted the study, but the damage was done. His study led to a drop in

immunisation levels and subsequent outbreaks of these diseases, claims the WHO.

“Wakefield’s study has been rejected by the entire scientific community,” Professor Rees says. “There’s no evidence whatsoever that MMR vaccinations cause autism.”

Despite this, some still believe this myth. A possible reason for this is that autism is usually diagnosed at the same age as when

children get their MMR shots. But that’s the only association between the two, adds Dr Van Zyl. “There’s absolutely no evidence that MMR vaccinations cause autism.” Possible side effects of are too risky The MMR vaccination can cause seizures in one out of 3 000 doses, but one child in every 1000 who gets measles will develop encephalitis (brain swelling), which can result in brain injury, developmental delay and ongoing seizures. Dr Van Zyl likens vaccines to seatbelts. In the majority of car accidents seatbelts save lives, but in rare cases they can cause injury or kill people. Still, the benefits of buckling up far outweigh the risks. They contain mercury, which is harmful While it’s true that some vaccines contain low doses of mercury, most are mercury-free. Even in those containing mercury, the levels are so low, that it’s harmless. “Your exposure to mercury in the everyday environment is much higher than what’s in a vaccine,” Dr Van Zyl says. What’s more, the mercury used in vaccines derives from the preservative thiomersal and differs from the type of mercury that causes poisoning, Baker says. Vaccines are superfluous – the body creates its own immunity 

It’s true the body can create its own immunity when exposed to a disease, but the price of becoming immune through natural infection can be high, warns the WHO. Haemophilus influenzae type b can cause mental retardation, rubella can result in birth defects, hepatitis B can cause liver cancer and measles can be fatal. Vaccines, on the other hand, are designed to mimic the natural infection, without causing it. Your immune system thinks it’s under attack and starts building antibodies. “When you have been exposed to the natural disease and then get re-exposed, your body thinks: ‘I recognise this’ and mobilises its immune response,” Professor Rees says. If you already have antibodies from the vaccine, your immune system can launch an immediate response. “If you’re unvaccinated and pick up measles, then your immune system can take up to two weeks to produce enough antibodies,” Baker says. Vaccinations for diseases eradicated in your country are unnecessary 

Infectious diseases are easily transmitted and in our interconnected world where people increasingly move across borders for work and travel, diseases are often only a trip away.

In SA the last reported polio case was in 1989, and the country was declared poliofree in 2006, but the disease is still endemic

in three countries – Nigeria, Pakistan and Afghanistan. South Africans who travel to Nigeria for example can bring polio back

home and if there’s a large enough population that hasn’t been vaccinated an outbreak can occur. During the Soccer World Cup tournament in 2010 American tourists picked up measles in SA and caused an outbreak at home on their return, says Professor Rees. Vaccinations should only be halted for infectious diseases that have been eradicated worldwide. “The only one we’ve been able to get rid of completely is smallpox,” Baker says. You don’t have to vaccinate if everyone else is already doing it

The belief that you can get away with not vaccinating if enough people in your community have their children vaccinated is risky.

“Measles is highly infectious. Very high vaccine coverage, up to 95 per cent, is needed to prevent the spread. That means if more than one in 18 children isn’t vaccinated, your child might be at risk,” Dr Van Zyl says. The best way to make sure your child is protected is to have them vaccinated.

Experts agree that you owe it to your community to get the necessary vaccinations. If enough people are vaccinated, herd immunity develops. This type of community immunity occurs when enough people are immunised to prevent the infection from spreading, protecting individuals who, for whatever reason, can’t be immunised. For example babies can die from whooping cough and are only properly protected against it once they’ve had their third vaccine jab at 14 weeks. If not enough people are vaccinated against whooping cough it could spread to this vulnerable group, resulting in infection and death. You don’t have to stick to the vaccination schedule 

Parents need to adhere to the vaccination schedule if they want to properly protect their children, Professor Rees warns. A huge

amount of research goes into when and how many doses are needed to build immunity.

For some diseases, for instance yellow fever, you only need a single shot, whereas children receive four doses against pneumococcal disease (an infection that causes pneumonia or meningitis).

The schedule is also country specific. “The vaccines included in our vaccine programme are based on the risks that are common in our country,” Dr Van Zyl says. He adds that waiting until a child is older is a bad idea.

“Measles is most severe in young children and they’re at highest risk of complications from the pneumococcus. Waiting makes no sense.”

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