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In
the case of MMR vaccination, doing nothing is the more dangerous choice
By Brian
Rotenberg
Expert Advisor EvidenceNetwork.ca |
LONDON, ON/ Troy
Media/ - Every day when I see patients in my surgical clinic, some are offered a
procedure to help them feel better. Whether it is a minor surgery like a
tonsillectomy, or something larger scale such as tumour resection, I have a full
discussion with the patient regarding the benefits and risks of doing
"something."
Each time I go over
the common minor risks of an intervention and the exceedingly rare but
potentially very serious risks that can occur. I also review with them the risks
of doing "nothing" - of what may happen if they don't have surgery.
Vaccination is no
different. Vaccination involves an injection in order to provoke the body's
immune response to protect against an outside infection. Like all medical
therapies, vaccination has both its benefits and its relative risks, and an
informed patient or parent needs to balance the two.
In the case of the
Measles Mumps Rubella vaccination (also known as MMR), its overwhelming success
in eradicating deadly diseases of childhood speaks clearly to the benefits.
However, it has become fashionable in society recently to hold vaccination to a
different standard than most other medical risks individuals generally accept
when they receive healthcare.
Understanding the
nature of relative risk can help to frame the issue into a clearer perspective.
Not all risks are the same, either in terms of likelihood or severity, and
sometimes the risk of doing nothing can be potentially more harmful than the
risk of doing something.
In the case of MMR
vaccination, the risks of doing something - of receiving a vaccine - include
relatively common but minor issues such as fever or a sore arm, and an
exceedingly rare severe allergic reaction called anaphylaxis.
The risk of doing
nothing - of not receiving a vaccine - at first glance seems very simple, that
being a higher likelihood of getting the disease the vaccine is designed to
prevent. In the case of measles for example, the risk of getting the disease if
an unvaccinated person is exposed to someone carrying the virus is very high,
close to 100 per cent. People who have measles then subsequently have the
further risk of developing a host of devastating medical problems including
brain damage, deafness or blindness.
However, there is a
more serious but hidden risk of doing nothing - not getting the MMR vaccine -
that being the risk of causing serious harm to someone else who hasn't received
the vaccine. Not all people can be vaccinated even if they wanted to be (e.g.,
very young children and people having chemotherapy) and because of this, they
are at higher risk for catching a contagious disease. Measles is one of the most
contagious diseases known.
In order to have a
low likelihood of transmitting measles to those who are unable to be immunized,
it is estimated that approximately 95 per cent of the population has to be
vaccinated. According to the Public Health Agency of Canada, the overall
country-wide MMR vaccination rate just barely meets that mark (based on the most
recently available 2011 data). If the vaccination rate begins to fall in
different provinces, our population will lose its overall immunity.
The media are
reporting daily new outbreaks of measles in children in Canada and the United
States, a scourge society once thought defeated. There appears to be a strong
cause-and-effect relationship between the emerging trend not to get vaccinated
and the growing number of new sick children.
The overwhelming
majority of cases of measles are in children who did not get vaccinated. This
fact should not be seen as surprising. For those children, the parents' decision
to do nothing is what allowed the virus to grow within them; in their case, the
decision to do nothing clearly outweighed the risk of doing something, with
potentially life-altering consequences.
Even these small dips
in the vaccination rate have had major consequences, so just imagine if the
trend continues?
Patients who are
considering not getting an MMR vaccination for themselves or their children need
to compare the relative risks of doing something versus nothing. In the case of
the MMR vaccine, doing nothing is the more dangerous choice - and it is putting
children, and society at large, at risk.
Dr. Brian
Rotenberg is an expert advisor with EvidenceNetwork.ca and an Associate
Professor in the Department of Otolaryngology - Head & Neck Surgery at
Western University, London,
Ontario.
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