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Vaccines

Vaccines
I would like to get frank to the point of being offensive when I would say that I cannot stand patients who google their symptoms. They come loaded with information, most of which is untrue or misleading and have a mental block to the information the doctor would educate them with. Whatsapp and google are the new age quacks and people are ready to give up everything and follow them blindly. Whatsapp forwarded infographic is the gospel truth and nothing can compete with that. Bangalore is the hub of dengue fever. Some guy spread the rumour saying that papaya leaf juice increases platelet count and everyone was scampering to secure papaya leaves. The full of goodness papaya was given the backseat and the bitter juice of the leaf was shoved down the throat of the poor patient as the elixir of platelet increase. And it was a self-perpetuating myth. Platelets will increase after they drop. If they drop too low, then the patient is given platelet transfusion to get him through the low platelet crisis. After that stage the body is on its own to manufacture platelets and increase its count. It is only coincidental that the papaya leaf juice is given, and the platelets are seen to be climbing up. You can give chewing gum to the patient religiously thrice a day believing in the power of gum and watch the platelets increase. The papaya leaf is not proven to increase platelets in the dengue patient. There is no harm in giving it. But it tastes horrible and the patient is better off eating the nutritious fruit rather than drinking that myth.
Social media propaganda has glorified as well as vilified many procedures, medicines and foods. Hot water with lemon is the king of all drinks and so is the upcoming raspberry tea. A brand of fried snack was disparaged to such an extent on social media that the company had to issue a press release debunking the rumours to save its reputation and sales. Vaccines too got a super bad reputation following a questionable study which claimed link between rise in autism to the MMR vaccine. Medical ethics were put under the microscope and vaccine manufacturers were questioned about their reliability. It is true that the big pharma and vaccine manufactures are in the most lucrative of businesses. Pharmaceutical and vaccine manufacturers do finance studies which inadvertently will have results favouring their product. But all this shoddy business aside, we cannot claim that we do not need any more medical drugs or vaccines. With all the information circulating on social media platforms I feel that it is my duty to strain out fact from fiction and present it to you.
Vaccines are linked to autism
In 1998, the scientist Wakefield published his findings linking the MMR vaccine to the developmental disorder Autism. In his paper he claimed that the children developed signs of autism within one month of receiving the MMR vaccine. The children were found to have some inflammation in their gut. This is claimed to be caused by the chemical ‘thimerosal’ used as the preservative in the vaccine. This study got a lot of publicity. It was thought to be ground breaking. But it was ridden with faulty scientific methods most peers couldn’t help noticing. For instance, there was no control group. The study was done in subjects who were already diagnosed with autism. There was no normal group for comparison.
Another red flag to the accuracy of this study was that the number of subjects in this study was shockingly a very small group of 8 children! A mere 8 autistic kids were evaluated. This study had bias written all over it. And it was just a matter of time before someone blew the whistle on these bogus claims. The paper was retracted from the publication later on as more scientists and doctors came forward disputing the findings by Wakefield. But the harm was done. The seed of doubt had been sown in the minds of many parents. And the study had left its footprint all over google. Whether it was true or not was not disregarded. Just the word autism and vaccine popping up together in the google search results was enough to shake the credibility of vaccines.
It has been proved beyond doubt that the MMR vaccine is not linked to autism. The original paper by Wakefield blamed the compound thimerosal for the effect. Even though the quantity in the vaccine of the compound was very little and manufacturers argued that it is too less to cause an effect on the child, it was nonetheless not included in the subsequent vaccine batches.
In effect what Wakefield did was create an unnecessary burden for doctors and scientists to write scores of articles online against Wakefield’s claims, explain to reluctant parents the importance of vaccines and waste time and money in scientific studies to disprove his original claims.
Many parents who have done their research do understand that the study was discredited but still have a ton of reservations against vaccines. Here are some of the frequently asked questions I have encountered by vaccine skeptics.
Q. Combination vaccines can cause exposure of children to too many antigens in one go. Is it safe?
To answer this question let me explain some vaccine related terminology. Most people are aware that vaccine causes production of antibodies by the recipient’s body. The substance which provokes the body to produce antibodies and mount an immune response is called an antigen (antibody generating substance). Now an antigen can be anything. It can be a virus, it can be a component of a virus used in the vaccine, it can be killed bacteria or virus or it can be an alive but weakened virus/bacteria. Most vaccines contain such components of virus.
To answer the question of efficacy and safety of combination vaccines, let me take you to the sandpit your child last played in. In the half hour your kid played in the kiddie play area you will have stopped him from taking a fistful of sand and putting in his mouth. You will have taken him on the carousel and let him enjoy the gentle round motion. Because he is so little you have sat on the swing with him on your lap and let him laugh while you both went to and fro. You would have taken him on the slide and held him while you made him slide down slowly. After you got home you left the baby on the floor while your hands. By the time you take him to wash him up, he was sucking on his fingers waiting for mumma. In this entire period of play, he has held the rail of the carousel, touched the sides of the slide and probably tried to eat a pair of slippers lying around in the sand. He has tried to eat a handful of mud too. This is enough to expose you little child to thousands of bacteria and his body has come in contact with atleast 30-40 antigens. His innocent immune system is getting acquainted with the big bad world outside and revving up its engines to bulldoze its way around the pathogen filled playground. And you don’t need to freak out by this information you just read. This is the rite of passage for the healthy development of your child’s immune system. Along with him even you encountered all those pathogens and your body already has antibodies to those or will develop. And in the next feed you will give your immunity to your child through your breast milk.
So when you give a combination vaccine to your child, you give him about 20 antigens depending on the vaccine. And if the baby is healthy, then it is okay to go ahead with the combination.


Q. My child is healthy and breastfed. I had been immunized as a kid. I will be transferring my antibodies to him. That’s sufficient right?
No that isn’t sufficient. Take for example the scenario in USA. Measles was declared eliminated at the turn of the century. But a decade and half later the Centre for Disease Control is getting more and more patients as each year passes by. This is because many parents are opting out of vaccinating their children. In 2015 beginning there was an outbreak of measles in children who visited Disney theme parks. About 125 cases were reported. On closer inspection, majority of the kids were unvaccinated or had unknown vaccination status.
This is an alarming news because of 2 reasons. Firstly, a disease that was claimed to have been eliminated in the year 2000, has reemerged as public health concern because of parents dropping out of vaccination due to the alleged autism risk. Secondly, it is a vaccine avoidable disease and the burden of care on the shoulders of the healthcare system and parents is very high. Measles is a highly contagious disease. Just walking in the area, a measles patient coughed or sneezed in can transmit the disease. Also, the morbid effects of a measles infection should serve a cautionary tale to parents still mulling over their decision to vaccinate their child. Pneumonia, brain damage due to encephalitis and a long-standing diarrhea are some of the most notorious effects of measles. And all this can be avoided by vaccinating your child.
Q. If other kids are vaccinated, I can skip vaccinating my child, right? There won’t be anyone to transmit the infection to him.
I am glad you said that. Because you yourself have introduced the concept of herd immunity. Vaccination is not just in the interest of an individual child. It is a public health effort and to maintain the health of the community too. So when you vaccinate your child, you are removing him from the pool of “infectable” individuals and placing him in the pool of immunized individuals. As the pool of “unimmunized” individuals dwindles by efforts at vaccinating the majority, the carriers of the virus also decrease. Even if an immigrant with the disease comes to the population, the infection will not be able to get transmitted as most people are immunized. This effectively protects the very young, very old and those with poor immunity from getting infected. This is called herd immunity. Basically if enough individuals are immunized against an illness through vaccination, then the population is resistant to the spread of that contagious disease.
If more and more parents avoid vaccines, the herd immunity of the population is not achieved and outbreaks (such as those of measles seen in USA in the last few years) can occur and put more people at risk.
Q. Okay I will vaccinate my child. But do I really need to give him so many doses? Just one dose isn’t enough?
Yes, booster doses are necessary. Every individual reacts differently to a dose of vaccine. Some individuals mount a sufficient response in the first dose itself while some don’t develop any response to the dose. Most individuals develop a short-lasting response. With booster dose, the antibody response is stronger and lasts for a longer time. For small children it isn’t feasible or practical to draw blood and check antibody titres to see if there is a need for booster doses. It will mean more pricks to the child, more hospital visits and more expense to the parents. To bypass the uncertainty of single dose response, booster dose is given. Some individuals don’t develop antibodies at all inspite of being healthy, so for such people herd immunity plays a vital role for protection from the infection.
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