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  • Writer's pictureDr. Thomas Falls, MD

Vaccines Matter! Part I

I have read several recommendations for physicians not to make public comments or social media posts regarding vaccines (immunization). However, I continue to see daily stories about declining rates of confidence in vaccines, and increasing numbers of measles cases all across the country (and throughout the world!). So, while I am not a primary care physician or pediatrician - I still have quite a bit of experience dealing with the outcomes of unvaccinated children and adults. I admit that I have some bias in my training, as my medical school (Rochester) has a long history of vaccine research and development. However, I was not 'indoctrinated' during medical school, nor am I a 'pawn of big pharma' (in fact, I have never seen a drug rep for a vaccine if they even exist). Historically vaccines were considered low profit margin by most pharma companies, and while that has

changed recently, it doesn't change the billions of dollars in R&D that has (and will continue) to go into vaccine research to help prevent disease. Don't forget about smallpox, a scourge of mankind, that has been eradicated in the wild because of immunizations - and as a result you no longer need immunity to it. It's gone, wiped off the face of the planet because of the work done by scientists and clinicians.

Before I get to what I have seen professionally, I do have some personal anecdotes. When I was in first grade I got chicken pox - I remember distinctly having to miss an end of the year walking field trip to the library, and I was quite upset. However, I had a very mild case and in a few days was over it. My younger sister on the other hand, then 3 years old, had quite a bad case but recovered uneventfully as well. Since that time, a varicella (chicken pox) vaccine has become available and prevents most children from ever contracting this one ubiquitous disease. More importantly, gaining immunity through vaccine rather than disease in this case has another benefit - it prevents shingles from occurring as an adult (more on that later). Interestingly, at some point during my medical training I had to get some antibody titers drawn (to prove that I had been appropriately immunized). It was not a terrible surprise to learn that I did not have antibodies against varicella. My childhood immunization record contained "physician recorded" evidence of disease, and I have no doubt that I did actually have a very mild case of the disease. However, it was apparently so mild that my body didn't have a chance to mount a lasting immune response, and no long term antibodies were created. So, I ended up receiving this vaccine as an adult.

As I said before, what makes chicken pox different from other diseases is that even once you get over the illness, the virus never actually goes away. Your body wins the battle, but the war never ends. Varicella is a herpes virus and very difficult to actually eradicate. Instead it hides in the body, sometimes for decades being kept in check by a healthy immune system. However, sometimes in older adults, or those with compromised immune systems it can reactivate and cause shingles (herpes zoster). This happened to my maternal grandmother before I was born, and she ended up with ophthalmic (eye) involvement and lost the sight in one eye as a result. More commonly shingles causes a severely painful rash, but up to 10-15% of people affected can end up with a persistent, burning nerve pain (post herpetic neuralgia), which can be very difficult to treat.

So, why does this all matter? Well for one I just simply think that vaccines are important and 'walk the walk'. I recently went to Africa and got updates on a numbers of vaccines including a few new ones. Apparently my mumps titer was low, so I got an MMR booster. Somehow I never received the meningococcal vaccine (oops, mistake there), and I guess it wasn't required when I was in school - but I was traveling to part of the 'meningitis belt' of Africa, so got that one too. Among other shots that day, also got my yellow fever vaccine. Sure its a requirement to enter Uganda - but I also just really don't want yellow fever! And, in an update from prior recommendations, it is now a once in a lifetime vaccination. But the other part of this that's important is many people fail to realize that varicella can actually be dangerous, or even know that chicken pox can lead to shingles later in life. People hold an antiquated belief that chicken pox is a harmless childhood illness. Case in point - Kentucky Governor Matt Bevin recently told reporters that he purposefully exposed all 9 of his children to an infectious neighbor, leading to chicken pox in all of them. Besides being on the wrong end of science on this issue, it is just simply dangerous for elected officials to be spreading misinformation (even if in all likelihood, they do not mean to do so).

Ok, enough for now. More later. Between medical school and orthopaedic practice I have seen more than enough negative outcomes from preventable diseases. It's almost like watching someone not wearing a seatbelt being thrown through the windshield. Any description of it should be bad enough, but seeing it in person really burns the memory into your brain.

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