To vaccinate or not to vaccinate

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Abstract

In many countries national bodies (usually the Ministry of Health) oversee and recommend vaccinations of the population. In the US the Center for Disease Control and Prevention (CDC) recommends routine vaccination to prevent 17 preventable diseases that occur in infants, children, adolescents or adults (1). In most countries there does not exist any mandatory vaccination laws and the decision to vaccinate usually falls on the parents, who have to decide on behalf of their children. In the US all states require certain vaccinations for children entering public schools and usually children must be vaccinated against mumps, measles, rubella, diphtheria, pertussis, tetanus and polio. There are medical exemptions to vaccinations and most states permit religious exemptions and some allow exemption for philosophical reasons. In the twentieth century one of the effects of improvements in public health has been an increased life expectancy in the developed world. One of the 10 greatest achievements has been the vaccination coverage, which in effect has resulted in the longer and healthier life (1, 2). Diseases that 50 to 100 years ago killed millions of people are now avoided due to vaccination. There are pro and cons to vaccinations, which are not without risks, but public health professionals believe that the benefits far outweigh the risks. Opponents argue that the human immune system can deal with most infections and that natural immunity should be allowed to develop except where the side-effects are so serious that children are endangered. Varicella or chicken pox is usually a self-limited disease and vaccination has been provided since the mid1990s, but a recent case (3) provides food for thought. The introduction of the vaccination has resulted in substantially decreased incidence, hospitalizations and deaths in many countries. The case report (3) describes a varicella death in an unvaccinated, previously healthy 15-year-old adolescent, which was found on a routine review of vital statistics records. On March 12, 2009, the adolescent girl was admitted to a hospital with a 3-days’ history of a rash consistent with varicella and a 1-day history of fever and shortness of breath. She was started on intravenous acyclovir (on day 4 of illness) and broad-spectrum antibiotics and antifungals, but she died 3 weeks later. The source of exposure was unknown and she had previously received four doses of the diphtheria-tetanus-pertussis vaccine, one dose of Haemophilus influenzae type b vaccine and two doses of the measles-mumps-rubella vaccine, but lived in a community with low rates of varicella vaccination and she was generally healthy. This case should remind us of the importance of catch-up vaccination of older children and adolescents to prevent varicella and serious complications later in life.