Why Do We Vaccinate Kids?

Robert Brayden, MD, Associate Professor of Pediatrics, University of Colorado Denver and Children's Hospital Colorado, President of the Board of Directors of the Colorado Children’s Immunization Coalition

In the winter of 1964-65, the United States sustained an epidemic of rubella, sometimes known as German measles or three-day measles. More than 12 million Americans came down with the disease, and essentially all of them recovered.

So why the fuss? The problem was due to the fact that the virus injures a fetus. Twenty-thousand of those infected turned out to be pregnant women who would go on to give birth to children affected by the rubella virus. The children were born with birth defects, known collectively as congenital rubella syndrome. Affecting many body organs, the most serious influences of the virus on a growing fetus are on the brain, the eyes and the heart. Thousands were diagnosed with mental retardation. The estimated cost of taking care of these 20,000 affected children was $840,000,000. You can imagine the consequences in terms of heartache and loss.

In 1969, the first rubella vaccine was approved in the United States . In 2007, there were 12 cases of rubella in the entire country. Rubella had been reduced by a million fold. There was not a single case of congenital rubella syndrome reported.

Taken from this perspective, the reason we vaccinate is enormously clear. We improve our quality of life and save medical costs with a safe and effective vaccine. The same story can, to various extents, be told for every vaccine.

Vaccines however have become a victim of their own success. Many young parents today have never seen the 16 diseases against which we now routinely vaccinate. Diphtheria, tetanus, measles, mumps, rubella, polio—these diseases are virtually gone. Hepatitis A and B, and Haemophilus influenzae type B are fading away. Many medical students—much less parents—have not seen these diseases.

But there is still much to do. Preventing pertussis, chickenpox and Streptococcus pneumoniae can still be improved upon. In the first quarter of 2009 in Colorado , there were 71 cases of whooping cough, 194 of chickenpox and 197 of invasive Streptococcus pneumoniae. Meningococcal-borne diseases and influenza are also being reduced with vaccines, but we remain in the early stages of benefiting from their prevention. Perhaps someday in the future, cervical cancers triggered by human papillomavirus infections will be eliminated.

Colorado ’s vaccination rate—a proxy measure for vulnerability to disease—has risen into the middle of the rates for all of the states in the past five years. More than 91% of all vaccine series have been completed by American children and thus we should be able to prevent most cases of vaccine-preventable diseases.

Parents, however, remain concerned. One of the biggest concerns is the number of shots that kids get. At many doctor visits, kids will get three, four or even five or more injections. Parents are rightly concerned about the emotional consequences of these painful procedures. Without the reminders of disease, parents do not see the converse benefit of vaccination. The diseases however, will return without high levels of vaccination, thus creating a paradox.

The way out of this paradox contains many small steps. First, when a vaccine can be administered via nasal inhalation as opposed to injection, it should be done that way. The availability of nasal influenza vaccine needs to be improved and it must continue to be affordable.

Second, improvements in the way in which vaccines are combined into a single injection need to be made. In Europe , a six-valent vaccine combination is helping to reduce the number of infections. More combinations will likely be coming to the U.S.

Thirdly, bio-technology needs to discover new ways of administering vaccines that are currently given by injection. Skin patches administer many medications; perhaps vaccine antigens could also be delivered in this way. Perhaps antigens could pass through the stomach without being digested and later be absorbed in immunizing amounts from the gastrointestinal tract. These issues are complex and will take time to resolve.

Finally, some (but not all) of the diseases against which we vaccinate can be eradicated. Just like smallpox, the first disease to be eradicated intentionally from the globe, perhaps someday soon we will be able to declare victory over one or more vaccine-preventable diseases of humans and be able to cease vaccination entirely. Perhaps polio. Perhaps other diseases someday.

In the meantime, we need to maintain high levels of vaccination.

There are several actions we can take

• Access to a medical home for children is one of the most important ways of helping ensure timely vaccination. Medical homes are where the majority of medical care is, and should be, provided.

• We need to get the word out about the improvements in the quality of life and health as a result of vaccination. Funding and support of communications efforts will cost money, but think how much money we have saved as a result of vaccines. A fraction of this should support vaccination education efforts.

• Providers must have access to reliable and accurate information about vaccine preventable disease. As with communications efforts, we should spend some of the money we have saved on ensuring that we don’t have the diseases return.