Vaccines: Separating Fact from Fear

This video series answers questions many parents have about vaccines. It features the stories of several parents whose children suffered vaccine-preventable diseases.



Introduction: Vaccine Safety Concerns

Narrator: From the first day of life, our children depend on us to feed and clothe, nurture, and protect them. And we, in turn, depend on the best advice we can find. In recent years, concerned parents have begun to raise serious questions about the benefits and risks of vaccines, questions that deserve equally serious answers.

Parent: Mary Katherine was born soon after a friend of mine mentioned that she had concerns about safety and efficacy of vaccinations. So while I was investigating and trying to find out if she was right about this and problems with vaccines, I did not have Mary Katherine vaccinated.

Paul A. Offit, MD: As a parent, we will all want so desperately to do what is right, what is best for our children. And with regard to vaccines, I think there's a lot of conflicting information out there.

Narrator: Dr. Paul Offit is the Chief of Infectious Diseases and Director of the Vaccine Education Center at the Children's Hospital of Philadelphia. He is also a Professor of Pediatrics at the University of Pennsylvania School of Medicine and the father of two young children.

Paul A. Offit, MD: My hope is that by talking to parents about vaccines, what they are, how they work, and I think how they can still make such an important difference in our lives, that we can take the fear out of the discussion and focus, instead, on the facts.

Are Vaccinations Necessary?

Parent: Are vaccinations really necessary?

Paul A. Offit, MD: I think that vaccines are still necessary for three reasons: The first reason that vaccines are necessary is that for common diseases like, for example, chicken pox, a choice not to get a vaccine, is a choice to get the disease.

Louis M. Bell, MD: In most cases, it's a mild disease. In some cases, it's not. And it's in that--in this setting in the Emergency Department that we might see patients who have more severe cases of chicken pox.

Kathy Archison, parent:: My husband and I didn't really know. Sunday we just knew that Jonathan didn't feel well. You know, he could maybe walk about three or four steps, and then he would just double over in pain going, "Momma my belly hurts. I just can't walk anymore."

Louis M. Bell, MD: These are all children who very quickly went from being well to ill with complications from chicken pox, complications of pneumonia, of serious skin infections, of ataxia, and imbalance, from an inflammation of the brain, from a serious sepsis syndrome where they require Intensive Care Unit.

Kathy Archison, parent: The doctors had said what happened to John was he was basically invaded. His body was invaded. The reason--one of the reasons why he couldn't walk was because his colon was lined with the chicken pox. At the hospital when they put a breathing tube down him, blood was coming out and they couldn't figure out why. When doctors said, basically, Jonathan bled to death because nothing would, you know, nothing would stop the bleeding.

Louis M. Bell, MD: This is a mild disease, in general. But for a small group of children, it can be a devastating disease.

Kathy Archison, parent: I went in and seen him after he had died. And I just told him to save me a seat, you know. I don't get to kiss him good night. I don't get to give him a hug. Children are supposed to bury their parents. It's not supposed to be the other way around.

Louis M. Bell, MD: When I see parents come into the Emergency Department with these complications in this era, when there's a vaccine available, it's sad in some ways, and it also makes me think that we missed the boat as pediatricians.

Narrator: Before the chicken pox vaccine was first available in 1995, chicken pox killed 50 American children and hospitalized over 7,000 every year.

Paul A. Offit, MD: The second reason that vaccines are necessary is that some diseases kind of smolder below the surface like measles or mumps or German measles or haemophilus. And if we choose to lower immunization rates, even by just a little, we run the risk that there will be, again, outbreaks of those diseases in our country. And we need only look back about 10 years ago when between 1989 and 1991 when we had immunization rates against measles of about 70 percent, we had sweeping outbreaks of measles across this country.

Robert Levenson, Director, Division of Disease Control Philadelphia - Department of Public Health: Philadelphia was not one of the first cities to have a major measles epidemic. Los Angeles, Chicago, and other major cities had it a year before. So we knew it was coming. We were actually advising parents before measles had entered Philadelphia that it was coming and that children, especially preschool children, needed to be immunized. The message went totally unheeded; totally.

Barbara Watson, MD: Measles doesn't just hit the skin. It, basically, hits every organ system. So there's vomiting, diarrhea, and dehydration as well. And then the complications of the measles, the ear infections, the pneumonia, the seizures.

Robert Levenson: Every day we were getting 30, 40, 50 cases of measles called into us. And every case required that we investigate to confirm the diagnosis to identify susceptible people around the case and to work to try and get them protected. I got a call at 2:00 o'clock in the morning from the Medical Examiner telling me that a child died from measles. And then at 5:00 o'clock in the morning I got a second call telling me a child died from measles. And I said, well, I actually got that call three hours ago. And the Medical Examiner told me, "No, this is a second child who died."

Barbara Watson, MD: It was like, "Why is this happening? How could a developed country that has the facilities, has the expertise, has the money to prevent these deaths. How could this possibly be happening here in Philadelphia?"

Robert Levenson:: When the measles epidemic waned in the spring of 1991, we were able to document over 1550 cases of measles in the city, and there were 9 children who died from the measles.

Paul A. Offit, MD: The third reason that vaccines are necessary is that for diseases like polio or diphtheria, which have been either completely or virtually eliminated from this country, they haven't been eliminated from the rest of the world.

Huntly Collins, Medical Writer: Before going to India, I was under the impression that polio was basically no longer a problem in the world. After getting off the plane in Delhi and taking a taxicab into the hotel, polio was apparent on the streets. We could see what are known in India as "crawlers," people with polio having no wheelchairs, no crutches, pulling themselves along the ground and begging. So parents in India are very eager to get their kids vaccinated. By contrast, parents in the United States have forgotten that polio is a problem.

Paul A. Offit, MD: And let's face it, the world's just not that big anymore. International travel is common, and when people travel, the germs that infect them, travel with them. Recently, there was a little girl who came into Canada who was infected with polio. She was infected with polio because she'd recently been in a place where polio infections were occurring. Now, she was very contagious to those people in Canada. But the people in Canada didn't get infected because they were vaccinated with the polio vaccine. But if they hadn't been, the potential for an outbreak of polio was there.

Are Vaccinations Safe?

Parent: Are there any risks, and are they safe?

Paul A. Offit, MD: I think the heart of this, I think why we're here tonight, in some ways, is an attempt to answer the question, "Are vaccines safe?" All vaccines have mild side effects like pain or redness or tenderness where the shot is given, and some vaccines have more severe side effects. For example, the new pertussis vaccine, or whooping cough vaccine, is a very, very, rare cause of persistent, inconsolable crying, listlessness, lethargy, high fever. And so I think, any parent could reasonably ask, "Why not just avoid the risk and not get a vaccine?"

Marina Catallozzi, MD: Pertussis in its clinical form is really an awful disease and a devastating diseases to watch because there's really very little that you can do. In infants, specifically, you know, a young child is coughing; and we always think of it as a whooping cough. Young children cannot create a whoop, and so they basically become apneic. They stop breathing and turn blue. And this can happen at any time.

Kristine Macartney, MD:: Pertussis is very common in adults. In fact, it's a relatively common cause of an illness with prolonged cough in adults. And adults may not seek medical attention or be aware of what their infection is. They can then pass pertussis onto younger members of the family.

Marina Catallozzi, MD: Her two-month-old came in, wasn't breathing for a time, needed a breathing tube, was in the Intensive Care Nursery. The two-year-old was coughing and vomiting, unable to eat for a week. The four-year-old was coughing so horribly that she would ask for help before going into her coughing spasms. There was a 7-year-old and a 17-year-old, and each of those children really missed school for several weeks. The whole family was really adversely affected from something that could have been prevented. It's really hard as a caretaker to see the effect of choosing not to immunize.

Paul A. Offit, MD: For example, in Japan in the mid 1970s what happened when people stopped getting the pertussis vaccine is there was a dramatic increase in the number of hospitalizations and deaths from pertussis.

Marina Catallozzi, MD: The last thing I want to be doing is seeing a lot of measles cases or lots of polio cases or lots of cases of pertussis because I don't want to be good at those diseases. I want to see them really just in the textbooks.

Paul A. Offit, MD: We need to understand that vaccines certainly do have risks, but they're small. And if we choose not to get vaccines, then we're exchanging these small risks for much, much larger risks.

Why are There So Many Vaccines?

Parent: Why are there so many vaccines nowadays?

Paul A. Offit, MD: I think that the answer to that question lies in our past. My mother and father were children in the 1920s and the early 1930s, and at that time there was just one vaccine, the small pox vaccine. But they were lucky. They were lucky that they weren't one of the hundreds of thousands that got diphtheria, many of whom died. By the time my brother and my sister and I were children, which was in the 1950s and early 1960s, there were five vaccines. But we too were lucky. We are lucky that we weren't one of the tens of thousands that got bloodstream infections or meningitis or pneumonia from bacteria like haemophilus or pneumococcus. Now, our children get 11 vaccines. And while we still live in a world where there are viruses and bacteria in our midst that can cause permanent harm or death, we still do need vaccines to protect us.

Can My Baby Get Four or Five Vaccines at a Time?

Nicole's Mother: Nicole had just came out of Children's. She had to have four or five vaccines all at one time. It seems like so much for such a small infant to handle.

Susan Coffin, MD: Seeing four shots lined up on an examining table for your baby is an imposing sight. It does seem like a lot. And as a parent, I felt that it looked like a lot for my child to get, too. When a baby is first born, it seems as though a baby is very vulnerable and in many ways they are. But what we do know is that babies' immune systems are well developed before they are ever born. And that's important. It's important for babies' immune systems to be ready to encounter the hundreds of bacterias that will quickly cover the surface of their bodies and making sure that they don't cause infections in a baby. So a baby's immune system really is ready.

Is it Better to Be Naturally or Artificially Immunized?

Parent: Is it better to be naturally infected than artificially infected through a vaccine?

Paul A. Offit, MD: I think that both natural infection and immunization often offer, you know, lifelong protection against disease. The difference between the two is the price that one pays for natural infection. I mean, for example, before the measles vaccine, almost all children in this country got measles. And when they got measles, most survived the infection. And when they survived the infection, they had immunity that would protect them against measles for the rest of their life. But every year before vaccination, about 100,000 children would be hospitalized, and several thousand children would die from measles. And, obviously, I mean, hospitalization is a very high price to pay for immunity when you can get essentially the same immunity without having to pay a price at all through vaccination.

Let's take a specific example. There's a bacteria called pneumococcus, which commonly infects infants and young children.

Carla Newby, parent: I had my children vaccinated with every vaccine they were supposed to get. I thought they were protected. I had no idea that meningitis could destroy my entire life.

Narrator: Carla Newby's son, Jacob, died from meningitis when he was 6 years old. One month later, she joined the Meningitis Foundation of America and is now its executive director.

Carla Newby, parent: It was six months after Jacob died that there was a vaccine that was available that was going to protect children against pneumococcal meningitis. My personal mission is to eliminate meningitis. I want to work myself out of a job. Not many people can say that or would say that, but that's my goal. I want to eliminate it, and I won't stop until it is. I want my son to be able to look down and say, "Good job mom, I'm proud of you. You're doing something." So he keeps me going. Keeps me doing it.

Paul A. Offit, MD: Every year pneumococcus causes about 1400 cases of meningitis, about 17,000 cases of bloodstream infections, and about 70,000 cases of pneumonia in children less than 5 years of age. So what can we do to prevent this? Well, the pneumococcal vaccine is given as a shot at 2 months, 4 months, 6 months, and again at 12 to 15 months of age. So the children can get the antibodies that they need to protect them against this serious and occasionally fatal infection.

Is There a Link Between the MMR Vaccine and Autism?

Parent: Recently, we saw a television news report about something that really stuck in my mind, which was the link between the MMR vaccine and autism. Why wouldn't it just be safer to separate the measles, mumps, and rubella vaccine instead of giving it to a child all at once?

Paul A. Offit, MD: This is a very emotional issue. And it springs from a report that came out of the United Kingdom in 1998. And this was a report of 12 children that had neurodevelopmental delay, eight of whom had autism. And in all eight children, these investigators found that there were intestinal disturbances. And in addition, all eight children had recently received the combination measles, mumps, rubella vaccine known as MMR. And so they wondered whether or not the vaccine was actually causing the autism. So to answer the question, a study was done. It was done by Brent Taylor. It was done in 1999. And what Brent Taylor did was he looked at not eight but 498 children with autism who either had or had not received the MMR vaccine. And what he found was that children with autism were no more likely to have received the MMR vaccine or to have received it recently than other children. The strength of any scientific observation is that it be reproduced. That's important. And that observation has now been reproduced twice; Once again in the United Kingdom, a second time in California with the same result. MMR vaccination does not cause autism.

To completely answer your question, "Why not separate the MMR vaccine into its three component parts?" There is no evidence that MMR vaccine causes autism, therefore, there is no reason to separate that vaccine into its three component parts. And the downside of doing that, one, is that you are giving children three shots when they only really need to have one. Two, is there will be a period of time, if you space out those shots when those children will be susceptible to those, you know, diseases for which you haven't given them that initial shot.

Do Vaccines Cause Chronic Illnesses?

Clinician: When parents ask me to prove that vaccines do not cause chronic illnesses, what information can I give them?

Paul A. Offit, MD: Well, certainly not all vaccines have been examined to see whether or not they cause all known chronic illnesses. But, I mean, anytime we have looked, we've been reassured. For example, we now know that vaccines are not a cause of diabetes; that vaccines are not a cause of multiple sclerosis; that vaccines are not a cause of inflammatory bowel disease; that vaccines are not a cause of autism; that vaccines are not a cause of sudden infant death syndrome. So I think, you know, when we've looked, we've been reassured.

New Vaccines, Should You Wait?

Parent: You've been talking a little bit about some newer vaccines that are out on the market now. Wouldn't it maybe be a better idea to wait until there's more data on the new vaccines that are out?

Paul A. Offit, MD: I think that's a great question, and probably the best way to answer it is to look at our newest vaccine. The most recent vaccine that was made available in this country was a vaccine to prevent a bacteria called pneumococcus.

Susan Coffin, MD: Pneumococcal vaccine has been made using a strategy, which is virtually identical to that used in a vaccine for haemophilus influenza b. That's a vaccine children have been getting for over ten years

Paul A. Offit, MD: Now, here's a vaccine that has already been tested in tens of thousands of children for several years, and we know it to be safe. But a parent could say, "Well, why not wait five years or ten years until the vaccine has been put in millions of children so that I can just make sure." I think what parents need to realize is what we do know about pneumococcus. What we do know is it is the most severe bacterial infection of young children.

Carla Newby, parent: I rode with him in the ambulance down to the next hospital. When they got out of doing their triage and immediate care for him, they basically told us at that point that Jake was in a comma. He was on a respirator. He was not breathing on his own and that he wasn't going to make it. They fought for him for--it was 14 hours and 45 minutes later, and Jake was pronounced brain dead at that point.

Paul A. Offit, MD: So while parents are waiting to see whether or not the pneumococcal vaccine is safe five or ten years from now, they're taking the risk that every year their children could be one of those children that's permanently harmed or killed by that bacteria, and it is a risk that is simply not worth taking.

Susan Coffin, MD: In all cases, vaccines are undergoing what's called "post licensure surveillance." And those are actually research studies to evaluate a vaccine's safety once it's licensed. Parents may remember a recent episode with the rotavirus vaccine. That vaccine was licensed in the late 1990s to protect young children against serious gastroenteritis. But once it became licensed, there were very, very, rare cases where children actually developed problems likely related to the vaccine with their gastrointestinal tract. And within less than eight months, that vaccine was discontinued. No more children received it. And so I think that shows the ongoing surveillance and prompt responses that groups like the Centers for Disease Control have had in maintaining and establishing the safety of new vaccines.

Vaccine Safety: Good Information vs. Bad Information

Parent: With more and more of the population having access to computers, when you type in vaccinations, you get 20 pages of possible Web sites. How can the general public know the difference between good information and bad information?

Suzanne Walther, parent: I first started my search for information about vaccines while I was still pregnant with Mary Katherine. And the first place I looked was on the Internet, and I started looking at Web sites that said, "You cannot trust pediatricians. They make a living off of well-baby shots. You cannot trust pharmaceutical companies. They make a living off of giving kids shots. You cannot trust the government because they're lobbied by the pharmaceutical lobbyists. They spend a lot of money making them happy to make laws about vaccines." So all of a sudden everything became tied to the almighty buck. And I personally don't like to tie my child's welfare to somebody else's income.

Paul A. Offit, MD: It's hard, frankly, in this, the 21st Century to say things like, "Trust your experts." We live in a relatively cynical time.

Suzanne Walther, parent: I postponed vaccines, and at 11 and a half months of age, Mary Katherine came down with Haemophilus influenza type b meningitis. The very next morning in the Pediatric Intensive Care Unit, the Infectious Disease pediatrician came to me and asked me why didn't I vaccinate and I told him. He said, "What are your questions?" And I had a long list of them, and they were on the front of my mind at that moment. And he answered most of them very quickly, confidentially. And said, "I can back this up with documentation. I'll get it for you."

Paul A. Offit, MD: I think that there are experts have served us well. We certainly have had--we have now the highest rates of immunizations we have ever had in our country's history. And the result of that is that we have the absolute lowest rate of vaccine preventable disease. We've almost eliminated measles from this country. We have eliminated polio from this country. We virtually eliminated diphtheria from this country; diseases that routinely killed or permanently harmed children.

Suzanne Walther, parent: She did not die of it, by the grace of God. For 10 days at the hospital, I sat and read just article after article after article about specific vaccines, safety, the proof of their efficacy. I wanted to know they actually worked before I bothered with taking any risk. What were the risk of disease? What were the risk of the vaccines? And what adverse reactions had been reported but not proven? That was important to me.

Paul A. Offit, MD: Good science really rests on two foundations: One, that the science be published in a good reputable journal, meaning that the data or information has been reviewed by peers; and, secondly, I think most importantly, is that the data be reproducible.

Suzanne Walther, parent: When I finally got accurate information, I discovered that the risk of taking a vaccine is very, very, very, very small in comparison to the risk of getting the disease and the dangers associated to the specific diseases that are out there. I never dreamed that my child would get one of the diseases that was on the vaccine list.

Paul A. Offit, MD: As a doctor, I've had the misfortune of having to watch children suffer the severe and occasionally fatal consequences of infections. And I can tell you as a parent, I would no more send my children into a world without vaccines than I would put them in a car without a seat belt or a boat without a life jacket. I will do whatever I can to put them in the safest position possible, and vaccines offer that safety.

Related Centers and Programs: Vaccine Education Center

Last Reviewed on Jul 23, 2014