Q. Which age group often misses immunizations and why? What are the dangers involved in ignoring these immunizations?
A. There are so many vaccines recommended for babies and young children and proof of these is required to start school. Additionally, these immunizations are usually covered by insurance, including Medicaid. So despite the heavy requirement for kids, there is also fairly good participation.
Once someone gets into the preteen and teen years, the immunizations are still required for schools but not as rigorously, unless they participate in certain competitive sports programs. Colleges may require certain immunizations for entrance, but after that there are often no immunization requirements, except in the cases of certain types of employment, such as in the health care field.
Pregnant women are generally very motivated to get any recommended vaccines. They are also maintaining regular follow-up in general for the baby and so are typically up-to-date on their immunizations.
Therefore, young adults are probably the most likely to miss out on recommended vaccinations, particularly the flu shot and HPV vaccinations. The danger with missing the HPV vaccine is an increased risk of cervical cancer, rectal cancer and potentially an increased risk of head and neck cancer later in life. The dangers with missing the flu shot include influenza, pneumonia and even death even in young adults.
Q. Although the claims about a correlation between immunizations and autism have been debunked, what are the biggest myths and misunderstandings about vaccines still out there? How can those misunderstandings be corrected?
A. The biggest misunderstanding about vaccines is that they cause the illness that they are designed to prevent. That is, many people think that if they get the flu shot they will get the flu, or that flu shot causes the flu. This is just not true.
The flu shot is a protein conjugate and not an attenuated, or “live,” vaccine (unless you take the nasal Flumist) so it does not actually cause the flu.
If, however, one gets the flu shot and then is immediately exposed to another virus such as a common cold, that person may then be more likely to actually get sick with the cold virus, because his or her immune system is working on the vaccine, rather than fighting off the virus that he or she is actually exposed to. Therefore, there is some real advantage to taking the flu shot very early in the fall, or in the late summer as we have been starting to offer it over the last couple of years.
Q. What do you think is the single most misunderstood vaccine and why?
A. The single most misunderstood vaccine is of course the flu vaccine, and the HPV vaccine (Gardasil) probably comes in a close second. For one thing, people still get confused between the “stomach flu” or viral gastrointestinal illness, which is not influenza and not covered by the flu shot, and true influenza.
There are a lot of other flu-like illnesses that people might think are the flu, but are simply similar viral syndromes that are not covered by the flu shot. As I mentioned in the previous questions, people think that the flu shot causes the flu, or makes them sick. The bottom line is that if you have a 1000 people and you give them all the flu shot, and you have another group of a 1000 people, and you don’t give any of them the flu shot, less people in that first group will contract the flu and potentially die that year. That is very well established fact. Some people do have bad reactions to some vaccines that we do not always understand, and we have to respect that.
Q. Some vaccines are recommended and others are required by schools or workplaces. What vaccines for each age group do you think are the most important and should never be missed?
A. There are really several vaccines that are important for babies and children, but probably two of the more important ones for babies are the Pneumovax and H flu, because before these vaccines were available, babies and young children were much more susceptible to and often died of bacterial meningitis and pneumonia. These bacteria are still around if the vaccines are missed.
The Tdap vaccine is important because whooping cough is still a threat to young children up through early teen years, and the Tdap protects against this.
Gardasil is also important for preteens and teens, because it prevents HPV hopefully before exposure to this virus, which causes cervical, anal and head and neck cancers.
Pregnant women are more susceptible to the flu, and the high fever from the flu may harm the fetus, so the flu shot is really critical before or during pregnancy.
Q. What is the most important thing you want people to know about immunizations in light of National Immunization Awareness Month?
A. The most important thing to realize about immunizations during this month is that we have learned a tremendous amount over the last 2 centuries since the benefit of the vaccination process was first developed. When George Washington immunized some of our soldiers against smallpox during the Revolutionary War in a very crude way, this may have been one of the critical factors that helped us to survive and triumph then.
Vaccines now prevent two to three million deaths each year worldwide, and reduce the suffering of more than 200 million people annually. With every medical intervention, we must weigh the risk versus the benefit, but with the vaccination process, we make our bodies more resilient to so many ailments that killed our ancestors at a young age, and that are still lurking in the world today.
Margaret Reiker, MD, is a member of BJC Medical Group and on staff at Missouri Baptist Medical Center. She practices at Internal Medicine Specialists, which is located on the hospital campus at 3009 N. Ballas Road, Suite 387C, St. Louis, MO, and can be reached at 314-996-5900. Visit bjcmedicalgroup.org for more information.