14 October 2010

Weighing in on vaccinations

It is influenza vaccine season, and I spend a good deal of time trying to encourage my patients to accept vaccination. I firmly believe in the benefit of any vaccination for communicable disease, and I frequently have to defend my position.

Young parents are concerned about drugs administered to their children. As a mother and grandmother, I understand their worry about risk versus benefit. Statistics are hard to find, but the National Vaccine Injury Compensation Program (U.S. Department of Health and Human Services) indicates that, on average, 100 claims of childhood deaths per annum are possibly attributable to vaccine administration. These are claims, not necessarily fact, but there is no doubt that vaccines do result in death or harm for a minuscule number of vaccine recipients each year. Of course, if one of those unfortunate persons is a member of your family, it is a tragedy of undeniable magnitude and cannot be minimized.

I am old enough to remember the advent of modern vaccines. I remember standing in line at my local elementary school with my parents, waiting to get my sugar cube with the pink medicine. That was the beginning of the polio vaccine. This memory is attached to another one, about my mother’s friend.

My mother and I would visit this lady in her home, where she lived in a round metal tube, lying on her back. A machine attached to the tube made a whoosh sound every few seconds. My mother told me this was an “iron lung,” but it would be years before I understood its significance. I knew she had polio, and she seemed remarkably normal to me as she spoke and laughed with visitors, observing them in a mirror attached to the tube above her head. I’m not sure I understood she was always in that tube.

When I was in first grade, there was a girl my age that lived on my block but, because she was blind, went to a different school. Before she was born, her mother had rubella. In the late 1980s, I made several trips with a medical team to the Caribbean island of St. Vincent. Each year, we would provide medical care to students attending a school for the blind and/or deaf, who were also victims of their mother’s rubella infections. The measles vaccine has been available in the United States since the early 1960s, and U.S. incidence of measles-caused congenital illness has been largely overcome, while the developing world is still suffering the effects that vaccine can prevent.

The risk in developed countries, while lessened, is still there. Just this month, the World Health Organization (WHO) announced that its goal of eliminating rubella and congenital rubella syndrome had be
en moved from 2010 to 2015, primarily because of small, vaccine-averse populations.

When parents ask for my opinion of the risk of vaccines, I don’t equivocate. I tell them about my mother’s friend in the iron lung and the other effects of vaccine-preventable disease I have witnessed firsthand. I remind them that the last case of smallpox was in 1977, the direct result of a global vaccine effort to eliminate what WHO terms “one of the most devastating diseases known to humanity.” But I also tell them the choice is theirs and that it should be an informed decision based on history and science, rather than personal apprehension. It is a serious choice.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

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