Selfishness is not living as one wishes to live, it is asking others to live as one wishes to live.
Oscar Wilde

A week ago I had the opportunity to do a brief spot with Nia Wong on a Sunday morning news program on Channel 8 (KLAS-TV) in Las Vegas. Occasionally opportunities come up where a reporter is looking for a doctor to be the “expert” on a topical medical issue. Our communications team knows that I have just enough need for recognition that I am usually quick to volunteer. In this case the topic of the day was the start of flu season and the importance of getting an influenza vaccine; the flu shot. The interview went well and I was able to put forth a few facts about influenza and the need to get a flu shot. This was an important piece for me because as a pediatrician I am passionate about the topic of vaccination.

The “flu” occurs as a seasonal epidemic caused by the influenza virus. It begins in October, slowly ramps up to a peak from December through February and then ramps down over the next couple of months with a few cases still being recorded as late as May. There are two predominant subgroups of influenza, Influenza A and B. What is interesting about the flu is that every year the virus undergoes a genetic rearrangement causing just enough change in the virus so that every year there are immunologically different flu viruses. This fact has two significant effects. The first is that every year you need a flu shot. The second is that creating an effective vaccine is a highly educated guess by epidemiologists who need to predict the most likely three or four variations that will be a part of the coming year’s epidemic. Once it is determined which virus strains are likely that information is sent to vaccine manufacturers who have to rush to produce an adequate number of doses for the country. Each year roughly 150 million doses of vaccine are produced.

The flu in the United States in brief (source Center for Disease Control):

  • Cases: 9 to 36 million per year in the US
  • Hospitalizations: 140,000 (during 2011-2012) to a recent high of 710,000 (during 2014-2015).
  • Deaths:12,000 (during 2011-2012) to a high of 56,000 (during 2012-2013).

Patients at particular risk from suffering severe disease include the very young, the very old and those with chronic diseases such as asthma, chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF). The flu if you get it is characterized by high fever, severe muscle aches, and respiratory symptoms including difficulty breathing and hypoxia (a lack of oxygen in the blood). Having the flu can also predispose you to developing other conditions such as a bacterial pneumonia.The flu usually occurs 1 to 4 days following exposure and you can be infectious a day before you are symptomatic. Treatment with antiviral medicines can decrease the severity of the disease, but only if you begun them during the first couple of days following the start of symptoms.

The best way to avoid the flu, and its complications, is to get a yearly vaccine. Children six months of age and over should can be given the vaccine, and it is particularly important with those with chronic disease, and yes – pregnant women should be vaccinated to protect both themselves and their baby. After being vaccinated it takes about two weeks to be immunized.

A quick fact: you can’t get the flu from the flu shot. The vaccine is created from either inactivated (dead) flu virus or a vaccine made from bits and pieces of the flu virus made in a laboratory – never alive – just bits and pieces. Another fact: yes – you can get the flu even if you get the flu shot. Reasons for this include: 1) you were exposed to the flu during the two weeks your body was developing it’s immunity, 2) the flu shot every year targets the three or four most likely flu viruses, and they aren’t’ the only ones that are out there, and 3) the vaccine created that year may not be a good match for the viruses that are circulating. It is important to note that if you do get the shot and you do get the flu it is likely that your infection will be more mild. The Centers for Disease Control (CDC) has a wonderful website devoted to information about Influenza – https://www.cdc.gov/flu/index.htm.

Both in and out of the ICU I have taken care of many patients with the flu, and a few of them have died. I have never taken care of someone who died from the flu shot.

More broadly, the story of vaccination is one of the true miracles of the last 100 years. According to the Centers for Disease Control (CDC) vaccinations will prevent more than 21 million hospitalizations and 732,000 deaths among children born in the last 20 years.
https://www.cdc.gov/media/releases/2014/p0424-immunization-program.html

The value of vaccination programs worldwide is beyond question.

  • Smallpox, once responsible for roughly two million deaths per year, was eradicated by the late 1970‘s.
  • Polio fell from over 300,000 cases per year in the 1980s to only 2,000 cases in 2002.
  • Pertussis (whooping cough) has fallen from three million cases per year to less than a quarter of a million.
  • The Haemophilus influenza B (Hib) vaccine has reduced the incidence of Hib meningitis by 90 per cent in children.

This short list of success has not altered the fact that vaccination has a troubled image in the United States. Reasons include reports of problems with vaccine manufacture and spurious reports of vaccines (Measles-Mumps-Rubella or MMR) as a causative agent in the development of autism. A baseless association, but one that nonetheless has received celebrity endorsement and the imprimatur of the internet to give it life.

The pushback against vaccination is truly an example of a medical miracle damned by its own success. The very low risk of acquiring a complication from a vaccine rises relative to the risk of contracting the disease when that disease has nearly been eradicated. In the 1950‘s polio outbreaks caused more than 15,000 cases of paralysis each year in the United States. (https://www.cdc.gov/polio/us/index.html) Wards of patients on ventilators suffering from paralytic polio was a too common reality. Because of the elimination of wild polio virus in the US in 2000 only the injectable polio vaccine has been used in the United States. This was done to eliminate the risk of vaccine-derived poliovirus that can occur with oral polio virus vaccine. However small this is a risk which is currently greater than the risk of acquiring wild polio in this country. derived infection reported worldwide. This is vanishingly few cases, and it is not zero. To complete the story of polio – there is no specific treatment, and so accepting the risk of not being vaccinated is accepting the risk of developing a severely debilitating and potentially fatal disease for which there is no cure. Counting on others being immunized to protect yourself is simply selfish.

The pediatricians in our medical group are faced with a rising number of parents who refuse to have their children vaccinated. This puts the doctor in a difficult position. They are being told to put their patient, the child, at risk and to do so against their professional judgement. It is accepted that a child does not have the ability, for the most part, to make medical decisions for themselves. Therefore, parents are given decision making capacity because it is believed that a parent has the best interests of their child at heart. However, we do not accept that a parent “owns” their child and a parent who knowingly acts to harm their child is guilty of abuse. The conflict felt by the doctor is between wanting to care for the child and not wanting to alienate the parents. A non-vaccinated child who becomes critically ill or dies from pertussis is little different than the child who dies in a car accident when the parent fails to put them in a safety seat. Many doctors have chosen to stop seeing these children due to this ethical compromise.

One funny aspect of the spot I did with Nia was that when I suggested that it would be a nice touch if I gave her a flu shot on the program the reaction I received from our communications staff, my colleagues, and the staff in the clinic was the same. “You are a doctor, do you know how to give a shot?”. I assured them I did and had given dozens upon dozens of immunizations, and then I practiced on a good friend of mine before the show.