It was late afternoon on a Friday when I got the call that there was a 5-year-old child with pneumococcal meningitis in the emergency room that needed to be admitted to the hospital. It was the first case like this that I had seen in many years. Meningitis is an infection of the covering of the brain and spinal cord, and pneumococcus is one of the bacteria that commonly caused meningitis in children before we started immunizing them with the pneumococcal vaccine in 2000.
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This vaccine is 96-percent effective in protecting children. Since that time, there have been few cases of this type of meningitis in the United States. Meningitis is a very serious disease that can cause brain damage, deafness and death. It turned out that the specific type, or "strain," of pneumococcus that infected this boy was one that the vaccine would have protected him against. So I wasn't surprised when his mother told me he had not been immunized with this important vaccine.
Why, I asked her, had she not immunized her child? She said that she felt that little babies were too weak to handle vaccines, that their immune systems might be overwhelmed by so many vaccines. She therefore delayed all vaccines until he was older than two. This belief is so unfortunate because it's the youngest children that need the most protection. Now he lay in the pediatric intensive-care unit unable to even respond to his mother's voice.
We're all aware of the measles outbreak at Disneyland that started in late December of 2014 and has continued into February. Most of the children who got measles were either unvaccinated by parent choice or too young to be vaccinated. Last year there were about 650 cases of measles in the U.S., most of which were directly or indirectly related to parents declining immunizations for their children.
As a pediatrician, a parent and a grandparent, I know that childhood vaccines are extremely safe and have saved countless lives. Vaccines have been the most important advance in medicine in the past 60 to 70 years. So how did we get to the point we find ourselves at today, with parents refusing to allow their children to receive lifesaving vaccines?
Parents' concerns are based on a confluence of different causes. First, vaccines are victims of their own success. Childhood immunizations have been incredibly effective in fighting childhood diseases. Most parents today have never seen a case of measles, rubella, meningitis, polio or pertussis. They have lost the fear of those illnesses.
Fear of vaccines, encouraged by now-disgraced researchers, celebrities, Internet postings and media hype, has become much more powerful than fear of these diseases. Although many studies have shown no relationship between autism and either the MMR (measles, mumps, rubella) vaccine or thimerosal in vaccines, these beliefs persist. Lack of understanding of science, especially of immunity, compounds the problem.
Parents like the mother of the child I cared for believe that vaccines stress the child's immune system. In reality, the few additional proteins that children respond to in vaccines are an infinitesimal component of the all the germs they are successfully responding to every day.
Some parents have religious beliefs that vaccines are inconsistent with trust in God. For others, belief in the pronouncements of their religious leaders has caused them to either delay or refuse immunizations. An even greater problem may be highly educated, affluent parents who feel their children can benefit from other children being vaccinated without "exposing" their own children to the perceived dangers of vaccines.
The measles outbreak this winter showed that "herd immunity," the protection of unvaccinated children by the mass of vaccinated people around them, breaks down when there are enough unvaccinated children to get and spread infections in communities.
I am hopeful that recent outbreaks are turning the tide against "anti-vaxxers." However, there are a number of actions that I think we need to take:
First, responsible media needs to stop equivocating about the science. Vaccines are extremely safe and lifesaving. So-called fair and balanced reporting of both sides of the argument has to stop. This is not a matter of opinion, but of scientific evidence and public health and safety.
Second, unvaccinated children are a danger to the children around them, especially those who truly can't be vaccinated because they are too young or because their immune systems are compromised. Parents should understand that their unvaccinated children might not be able to be admitted to day care or attend playgroups. I recommend that parents ask other parents whether their children are immunized before agreeing to playdates or attendance at birthday parties.
States need to reconsider exemptions for immunizations for philosophical and religious reasons at school entry. Let's wake up to the truth: Childhood diseases are the real enemy, and childhood immunizations are both safe and effective as our best weapon against them.
Readers -- Did you receive vaccinations as a child? Do you think parents should be required to vaccinate their children? Why do you think parents choose not to vaccinate their children? Leave a comment below and let us know.
Bernard P. Dreyer, M.D., is president-elect of the American Academy of Pediatrics. He is professor of pediatrics at NYU Langone Medical Center and director of pediatrics at Bellevue Hospital Center in New York. Dr. Dreyer is a pediatric hospitalist and developmental-behavioral pediatrician. Learn more about childhood illnesses and immunizations at HealthyChildren.org.
Connect with Dr. Dreyer on Twitter.