Science Correspondent

Most American parents take it for granted that their children will be able to avoid serious infectious diseases, but recent outbreaks of measles in New York City and in other parts of the country have brought the issue of infectious disease prevention via vaccination to the forefront. Because of misinformation and unfounded suggestions of a link between vaccination and autism, some parents have decided to forgo vaccinating their children. The unvaccinated children are at risk of developing diseases that are now rarely seen in the United States, and they put other individuals at risk as well.

At a recent program sponsored by the Parenting Center at the YM-YWHA of North Jersey in Wayne, pediatrician Dr. Vera Bennett spoke about childhood vaccines, addressing some of the controversies related to the topic.

"We can now vaccinate against 16 preventable diseases," reported Bennett, whose practice, Pediatric Multicare, is in Pompton Lakes. As an example of an effective vaccine program, Bennett said, "We don’t vaccinate against smallpox because we’ve gotten rid of it [through worldwide vaccination programs]. Before the vaccine there were 13,000 to 20,000 cases of smallpox in the United States each year."

The vaccines available to American children include: measles, mumps, and rubella (in the combination MMR vaccine); diphtheria, pertussis, and tetanus (in the combination DPT vaccine); polio, varicella (chickenpox), hepatitis A, hepatitis B, Haemophilus influenzae Type B, Streptococcus pneumoniae, Meningococcus, HPV, rotavirus, and influenza. (See sidebar.)

The fact that vaccines are so effective and can significantly reduce the incidence of certain diseases results in a situation where people who have never witnessed these diseases become complacent about the risks and threats of communicable disease. Polio, measles, mumps, rubella, diphtheria, pertussis, and tetanus are still serious threats in areas of the world where vaccination is not performed. "Polio is still endemic in Afghanistan, India, Nigeria, and Pakistan," said Bennett. These diseases still have the potential to cause permanent damage or death.

There have been suggestions that preservatives in childhood vaccines, such as ethylmercury, which is found in thimerosal, may lead to a higher risk for autism or other complications. However, those speculations are not derived from scientifically sound research studies, she said.

"A child with autism had a genetic disease. But the judge decided to pay out before anything was proven, because it was easier [than going through a trial]," said Bennett, referring to a recent case that was widely reported in the media.

In an interview, Dr. Steven Schuss of Teaneck Pediatrics said that there is a tremendous amount of misinformation about vaccine safety, especially on the Internet. He recommended consulting reputable sources for scientific studies on the issue. "There are objective Websites, such as AAP.org [American Academy of Pediatrics] or WebMD, that have objective data from peer reviewed, verifiable sources," he reported.

One major scientific study by Kaiser Permanente showed no link between vaccination and autism. The organization, a not-for-profit integrated health plan that serves more than 8 million people in nine states, compared the incidence of autism before and after 2001. The research showed that although all but trace amounts of mercury were removed from vaccines after 2001, the prevalence of autism in California has continued to rise. Another study reported that despite removal of thimerosal from vaccines in Denmark in 1992, rates of autism continued to rise in that country. If thimerosal exposure caused autism, the rates should have dropped when the preservative was removed from vaccines.

As a pediatrician who has treated children with serious infectious diseases, Schuss voiced concern about parents rejecting childhood vaccination. "Very few people know what polio is like, because of the very successful vaccination program," he said.

In 1952, more than 50,000 cases of polio were reported in the United States; that epidemic left many paralyzed, with some victims confined to iron lungs to keep them alive. But by the early 1960s most American children were vaccinated and protected against that dreaded disease.

"When I was chief resident of pediatrics at Montefiore," a major New York medical center, continued Schuss, "I almost went into ICU [Intensive Care Unit] medicine. I took care of infants with Haemophilus influenza meningitis, and I felt that there was such a need to do something to help them. Then the Haemophilus influenzae Type B vaccine was developed, and the incidence plummeted. In the past 20 years, I’ve only seen one patient, a 9-year-old boy, who had invasive H. flu disease. I’ve never seen polio. I’ve seen a few cases of pertussis. I’ve seen measles, but I haven’t seen cases for a long time. People who haven’t seen measles don’t know how serious measles can be."

According to the Centers for Disease Control and Prevention, before the measles vaccine became available in the early 1960s there were hundreds of thousands of cases each year in the United States, tens of thousands of victims were hospitalized, and hundreds died. The CDC Website (www.cdc.gov/mmwr) reports that "measles elimination … was declared in the United States in 2000," due to an extremely low incidence, averaging 62 cases per year from 2000-2007. (There are still approximately 20 million cases of measles each year worldwide.) However, in 2008 the CDC reported an upsurge in the number of cases: In the first four months of 2008 there were 64 reported cases, and this is a source of concern for many parents and healthcare professionals. "The 2008 upsurge in measles cases serves as a reminder that measles is still imported into the United States and can result in outbreaks unless population immunity remains high through vaccination," reports the CDC Website. "Among the 64 confirmed measles cases, prior vaccination could be documented for only one person."

Many baby boomers have vivid memories of suffering through childhood diseases such as measles, mumps, rubella, and chickenpox. Most victims recovered, but some developed complications and a small percentage died. Adults who contract those diseases can be at high risk for severe complications. For instance, rubella in pregnant women can lead to spontaneous abortions in up to 20 percent of cases, or severe defects in the unborn child — including cardiac, cerebral, ophthalmic, and auditory defects.

Despite the lack of evidence connecting vaccines to serious complications, Schuss reports that some parents opt out of vaccinating their children. "I have a handful of parents who reject vaccination — less than 1 percent." But, he noted, "when there was an outbreak of measles, even the parents who don’t vaccinate came in asking for vaccines.

"If there were fewer kids vaccinated we would see the repercussions," said Schuss.

When parents choose not to vaccinate, it puts their own child at risk, but also exposes the general population to serious risk. One problem is that vaccines, when administered according to protocol, are only about 90 percent effective in conferring immunity. This means that even in a population that is 100 percent vaccinated, some individuals will not be protected against the diseases. But if most people are immune and don’t have the disease (a situation known as herd immunity), that protects the ones who did not become immune. In the recent measles outbreaks, some individuals who were not vaccinated brought the disease back from other countries, exposing the vaccinated (but not fully immune) population at home.

Schuss and his colleagues have scrutinized the recommended vaccine arsenal and the research that has been done to ensure safety, and they see significant health benefits from most vaccines. "Severe vaccine reactions are very rare," he noted. "It’s a terrible thing to happen, but a very rare event. On the other hand, in populations that are sick with mumps, the disease can cause sterility."

"There is one vaccine that we do not yet recommend, called RotaTeq," said Schuss. That vaccine, which protects against the rotavirus — which causes severe gastroenteritis — was developed to replace an earlier version of the vaccine called Rotazyme. "Rotazyme had problems associated with it, a higher incidence of intussusception, or telescoping of the intestine on itself [causing blocking or twisting of the intestine]." Schuss explained that RotaTeq does not yet have an adequate track record for safety, so he is reluctant to give it at this point. He said that his patients and their parents can avoid the serious consequences of rotavirus by carefully following recommendations for treatment of diarrhea and other symptoms. "We are not jumping in [to recommend it] since we have good parents who are careful with their children and when a child is sick they follow directions."

"On the one hand it’s important to be critical and careful about the use of vaccines, but on the whole, the vaccine program is an amazing gift to our society," Schuss concluded.

Bennett also spoke strongly in favor of childhood vaccination. "I do believe in vaccines," she said. Bennett, who is a mother of four, had all of her children vaccinated. "Personally I don’t have any cons for getting vaccinated," added Bennett. "Some kids develop fever, irritability, soreness at the site, and sometimes a rash one week to 10 days later. But there have been no documented cases of a deadly illness from a vaccine."

At the Y presentation, Bret Hartman, a chiropractor who received his degree from Life Chiropractic College in Georgia, challenged Bennett’s assertions of vaccine safety. He said that most chiropractors are "pro-choice, not anti-vaccine." One audience member voiced concern about his own family’s experience. His 7-year-old daughter, who has Type 1 diabetes, and his nephew, who is autistic, both were vaccinated. Now he has a newborn baby at home and is unsure whether or not to have her vaccinated.

"Diabetes is genetic, an autoimmune process, usually set off by a virus," responded Bennett. "And everybody wants to blame something on autism. There was a family with one child who had autism and the second was learning disabled. When the third child, a daughter, was born they decided that she would never be vaccinated. She was not vaccinated, and she is more strongly autistic than her brother."

"Forty years ago small children stayed at home with their mothers," Bennett added. "Now everybody’s in day care and everybody’s sharing everything. We’ve changed the course of diseases." And this has made childhood vaccination all the more critical, she said. "Personally I don’t think there’s another side to the issue."

Diane Berkowitz, a Wayne resident who is expecting a baby shortly, said after Bennett’s talk, "We’ve already decided to do the vaccines."

Samantha Burstyn, also from Wayne and soon to be a new mother, agreed. "I was vaccinated and I turned out OK. What could happen [to an unvaccinated child] is worse. Everyone has something wrong with them. People are looking for a reason — something to blame it on."

Chicken Pox (varicella virus): Highly contagious, usually mild, childhood disease with symptoms of rash and fever. Rare serious complications can include bacterial infections and brain damage. Chicken pox in pregnancy can lead to birth defects.

DTaP is a new, safer form of the vaccine formerly called DPT vaccine: Protects against diphtheria, pertussis, and tetanus.

Diphtheria: Bacterial infection that causes fever, sore throat, chills, nasal discharge. Complications can lead to paralysis and heart failure. Since 2000 there have been only five cases of diphtheria in the United States. The Soviet Union suspended vaccination for diphtheria from 1990 to 1999. In that period of time there were 150,000 cases, and 5,000 deaths in the Soviet Union due to diphtheria.

Pertussis, a bacterial infection, also known as whooping cough, can be fatal in infants. Complications can include pneumonia, encephalitis, or secondary bacterial infection. Adults who contract pertussis will have a severe, violent cough for three months (the "100-day cough"). They may pass it on to an infant or an elderly person, who may die from it.

Tetanus, caused by bacteria found in the soil, can enter the body through a puncture wound or deep cut. It leads to muscle spasms in the jaw, from prolonged contraction of muscles. It can enter an infant’s body through the umbilical cord, if the cord is cut with a dirty knife. Worldwide it kills 300,000 newborns and 30,000 mothers each year.

Polio is still endemic to Afghanistan, India, Nigeria, and Pakistan, so people who travel to those areas can be exposed to it. It can cause muscle paralysis and death. (Violinist Itzhak Perlman contracted the disease at the age of 4, in Israel. He recovered sufficiently to walk with crutches, and he performs sitting down.) There were a handful of cases per year of polio that were contracted from the oral (live attenuated) vaccine, so since 2000 only the injectable IPV, inactivated polio vaccine, is used in the United States. Since this change, there have been no more cases of polio in the United States due to vaccination.

Influenza causes high fever and muscle aches. An influenza epidemic in 1918 to 1919 killed tens of millions of people worldwide. Influenza vaccine is recommended for children at high risk due to other health conditions.

HIB, or Haemophilus influenzae Type B is, a bacterial infection that can cause meningitis (inflammation of tissues that cover the brain and spinal cord), which can lead to death. It can also cause inflammation of the epiglottis, joints, bones, skin, lungs, or heart.

Hepatitus A and B viruses can infect the liver. Hepatitis B is linked to liver cancer. Vaccines for both viruses are now available (Hep B vaccine is required for college students).

MMR Vaccine for measle, mumps, and rubella:

Measles virus is extremely infectious; 90 percent of people in the same household will catch it. Symptoms include rash and cold-like symptoms. It can lead to complications such as breathing and neurologic problems, including encephalitis (swelling of the brain) and brain damage. The death rate can be as high as 1 to 3 per 1,000 patients.

Mumps, caused by a virus, leads to swollen salivary glands, headache, and nausea. Complications can include meningitis or deafness and sterility in males.

German measles (rubella) causes low-grade fever and rash. In pregnant women it can cause spontaneous abortion, or severe birth defects in the child.

Meningococcal infections are caused by bacteria. The vaccine is recommended for those 11 to 12 years old and older, especially for college students living in dormitories. The disease, which progresses very rapidly, can cause limb damage, deafness, brain damage, and death.

Streptococcus pneumoniae or pneumococcus is the most common cause of bacterial meningitis, and can be lethal. Prevnar (PCV 7) covers the seven most virulent strains in one. (Since this has been given to children, there have been fewer ear infections due to streptococcus bacteria. However, pediatricians now see more ear infections caused by different bacteria.)

Rotavirus causes severe diarrhea, vomiting, and dehydration, and is a leading cause of death in developing countries. RotaTeq is a new vaccine for the rotavirus, replacing Rotazyme, which was linked to a risk of intussception, or blocking or twisting of the intestine.

HPV, human papilloma virus, is linked to an elevated risk of cervical cancer. Guardasil, which is now being aggressively advertised, protects against HPV, a sexually transmitted disease, and is recommended for females ages 9-26.