Q.
Why are there so many immunizations these days?
A.
I stopped doing general pediatrics in August 2006, and already there is such a change with immunizations. It is quite dizzying.
When I started my own office back in 1984, we gave infants a series of four diphtheria, pertussis and tetanus shots, three oral polios and a mumps/measles/rubella at about age 5 with a DPT booster. That was it. For the DPT, I charged $6.
Things have evolved dramatically. The old pertussis vaccine, which caused many reactions, was essentially the pertussis organism put in a blender, then stuck in the body. Crude but effective.
Immunizations since then have been refined. The new acellular pertussis vaccine has fewer reactions and is far superior, and there is an adult/older child version. We now immunize against 16 different organisms, some viral, some bacterial.
It seems that every few weeks, there is a new vaccine being started or an older one being reformulated or combined. Things are not as simple, but they are better.
How it works
For those who do not know how this works, immunization is like giving the person a little disease. You get a little measles and your body reacts by making antibodies. The body is good that way. Whenever it needs to create antibodies, it goes whole hog.
Think of how complex that is. Every cold virus, every little molecule that isn't supposed to be there, the immune system must recognize and then make the exact molecule to corral it so that white cells can destroy it. On this subcellular level, this is amazingly elegant and efficient. We can combat what is foreign without attacking normal tissue.
We can't do anything to better it. Our immune system can take care of so many types or viruses for example, yet modern medicine can only find a very few compounds that do anything. Immunization is trusting mother nature where we can't otherwise fight.
One of the great feats of modern medicine is the essential disappearance of bacterial meningitis. When I was a resident (1978 to 1981), we almost always had someone in the hospital with bacterial meningitis. Now, it is so rare that residents will go through their entire three years without seeing a case. It is news, and even a little panic, when it occurs.
What does the future hold? Is there any downside to all these vaccinations? We are always better in the short term. The longer term is more problematic. We really don't know what happens when this generation gets to be adult age and beyond. Much of what we thought might be lifelong protection, such as the single dose of the mumps/measles/rubella or the chickenpox vaccine, did not happen. (More shots, kids. Sorry.) Does this sort of immunity wane? Does the system fatigue? Do multiple vaccinations at the same time work as well long term?
As life goes on and there are more wondrous and often sinister diseases (AIDS, bird flu, etc.), there are greater challenges to prevention.
I find it interesting how unknown the process will be.
Fight thimerosal rumor
I can't leave this article without mentioning the thimerosal controversy. Thimerosal was a mercury-based preservative that was used in vaccines.
The evidence is very strong that it was not a cause of autism or autism spectrum disorders. Yet, this is a hard rumor to squelch. In my career as physician, I have never seen such persistence of a clearly false idea.
But it just goes to show you how mysterious and dynamic the whole immunization process is. It is hard to believe it actually works. Maybe our disbelief fuels the rumors.
(3/9/08)
Dr. Norton's column appears on the second Monday of each month in the Milwaukee Journal Sentinel and is reposted here. Contact Dr. Norton by phone at (414) 228-4800 or via e-mail.
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