Your Weekly Checkup: The Importance of Immunization

“Your Weekly Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

Order Dr. Zipes’ new book, Damn the Naysayers: A Doctor’s Memoir.

I have written previously about the need to get an annual flu shot (my wife and I got ours two weeks ago), human papilloma virus, shingles, and other types of vaccinations, but that “trust in vaccinations appears to be declining, especially in small pockets of people living in insular communities. This puts under-vaccinated children at risk for contracting preventable diseases.”

I also noted that “vaccination, along with the discovery of antibiotics, is one of the major public health success stories in the history of medicine. Despite this, the incidence of vaccine-preventable diseases such as whooping cough and measles, after falling to all-time lows, has begun to increase.”

The potential consequences expressed in those statements are becoming apparent. Recent data from the Centers for Disease Control and Prevention published in the Morbidity and Mortality Weekly Report show that 1.3 percent of children born in 2017 did not receive any vaccinations. This represents a four-fold increase from 0.3 percent in 2001.

The Advisory Committee on Immunization Practices recommends routine vaccination against multiple potentially serious illnesses, including hepatitis A and B, rotavirus, diphtheria/tetanus/ pertussis, influenza, pneumococcus, polio, measles/mumps/rubella, varicella, meningococcus, and HPV.

However, the falling vaccination rate means that an estimated 100,000 young children have not been vaccinated against any of these diseases. Children in rural areas and those without insurance have higher rates of not being vaccinated.

While these results are sobering, recent overall vaccination coverage among young children remains high, and most children are routinely vaccinated.

Since the number of children who have received no vaccinations by age 24 months has been gradually increasing, the results highlight areas for improvement, such as educating parents who refuse to let their children become vaccinated and creating vaccination opportunities for rural populations and the uninsured. It is important to stress that most of the vaccines require more than one dose, with many of those multiple doses administered in the first year of life. We need to place greater emphasis on those vaccines that require booster doses.

The increasing percentage of unvaccinated children raise concerns about potential pockets of susceptibility where children are not well protected. For example, measles was declared eliminated from the United States in 2000, yet outbreaks caused by imported cases continue to occur each year; 118 measles cases were reported in 2017. The continued occurrence of measles outbreaks in the United States underscores the need to ensure high vaccination coverage among all young children.

Vaccines work not only by inoculating individuals from contracting a disease but also by creating herd immunity. When more than 80% to 90% of a population is vaccinated, chains of infection are likely to be disrupted, stopping or slowing the spread of disease, which protects those few not vaccinated. Therefore, not immunizing the few can affect the many.

Reduced vaccination rates around the world can cause outbreaks among Americans, as under-vaccinated Americans may become infected while visiting places with weaker herd immunity and carry the virus or bacteria back to the states. International travel also provides the opportunity for infected individuals to come in contact with susceptible Americans.

We can do better. Preventing disease is far preferable (and cheaper) than having to treat it after it occurs.

Be smart. Prevent disease with appropriate immunizations — in your children and in yourself. The minimal risks and expense are far less than contracting and treating the disease.

Your Weekly Checkup: The Controversy Around the HPV Vaccine

“Your Weekly Checkup” is our online column by Dr. Douglas Zipes, an internationally acclaimed cardiologist, professor, author, inventor, and authority on pacing and electrophysiology. Dr. Zipes is also a contributor to The Saturday Evening Post print magazine. Subscribe to receive thoughtful articles, new fiction, health and wellness advice, and gems from our archive. 

Order Dr. Zipes’ new book, Damn the Naysayers: A Doctor’s Memoir.

Two weeks ago I wrote about the need for vaccinations to prevent common infections with viruses such as measles, mumps and whooping cough. I didn’t have space to discuss vaccination against a highly important and more controversial infection: the human papillomavirus (HPV). More than 200 related HPV viruses exist, with about 40 having potential transmission through sexual contact.

HPV infection remains one of the most common sexually transmitted diseases in both males and females. Many infections do not cause symptoms, and nine out of ten disappear spontaneously in two years. However, HPV types 16 and 18 have been implicated in causing cancers and HPV 6 and 11 in causing warts. Worldwide, HPV infection is responsible for half a million cases of cancer and more than a quarter of a million deaths every year, with the highest incidence in developing countries lacking resources to promote prevention or provide treatment. Nearly 80 million Americans (about one in four) are infected with HPV, with over 6.2 million new cases annually. HPV causes 32,500 cancers in American men and women each year. HPV vaccination can prevent about 30,000 from ever developing.

Effective HPV vaccines have been available for almost a decade. More than one hundred countries have adopted vaccine programs for females, and many are extending the indications to include males. However, widespread adoption of vaccination remains controversial.

While state-mandated immunization programs have increased the number of children vaccinated, many state legislatures do not require universal HPV vaccination. Objections include the concern that the vaccine might encourage sexual contact at earlier ages or promote higher risk sexual practices. To me, the argument that the vaccine will prevent sexually related cancers appears far more persuasive.

The Centers for Disease Control and Prevention (CDC), together with other professional associations, recommends that children 11 or 12 years old get two shots of HPV vaccine six to twelve months apart. In general, HPV vaccine is recommended for young women through age 26, and young men through age 21. The overwhelming evidence favors administration of the vaccine to prevent the precancerous and malignant disease conditions caused by HPV infection. The risks of the vaccine are within the range of complications noted with other vaccination programs and should not prevent vaccine administration. Parents and health care workers need to be educated that the benefits of HPV vaccination far outweigh any risks.