Why I Immunize: Part III

This is the third of a series of entries about disease prevention and medical treatments.  To understand what has been covered and why some topics are mentioned or not, please be sure to read the previous entries about hygiene practice and healthy diet choices for disease prevention. 

While no one method is perfect for all people, the next logical step for most parents in prevention of illness is choosing to provide immunity through vaccination.  Not all people will choose to participate in vaccination due to a number of concerns, but it is impossible to make a reasonable decision if valid information is not available.  I am picky about my citations here and want to avoid false information and shoddy sources; this means while I acknowledge that she is considered an authority in the anti-vaccine movement, I will not be quoting material from Jenny McCarthy

In an attempt to understand the benefits of vaccines and why a parent would take the risk of exposure or reaction, we will explore a vaccine recently in the news for achievements in the eradication of a serious problem as well as known and assumed dangers related to it; I am speaking here about Poliomyelitis, often called "Polio".

Why I Immunize: Part III - Polio and Vaccine History

On January 13th of 2014 the announcement came that India, a country known for massive outbreaks of otherwise preventable diseases because of widespread sanitation problems, was declared "Polio Free" for a full three years.  This is still being verified by the World Health Organization and other sources, but marks a huge step along the path of eliminating a disease lethal to children and adults because of the regular practice of vaccination.  Two years free of disease is often the time at which efforts to continue vaccination begin to fail in public view that the risk is already gone.

The CDC defines Polio as "a crippling and potentially deadly infectious disease caused by a virus that spreads from person to person invading the brain and spinal cord and causing paralysis.  Because polio has no cure, vaccination is the best way to protect yourself and the only way to stop the disease from spreading. The spread of polio has never stopped in Afghanistan, Nigeria and Pakistan. Poliovirus has been reintroduced and continues to spread in Chad and Horn of Africa after the spread of the virus was previously stopped.".

The virus is spread by fecal-to-oral contamination, meaning poor hygiene is once again a factor in transmission.  While this means that proper washing of hands and other sanitary practices should be instituted to lower risks, the lack of clean running water can prove problematic.  Fecal contamination in the water supply has already shown in widespread Cholera outbreaks in even the most modernized areas, making sanitation a problem at all levels and thus an ineffective method of prevention in this situation.

The vaccine for Polio was created by Dr. Jonas Salk in 1952 and released for public use in 1955.  By 1957 the American government made their first push into inoculation by starting a well funded campaign to provide vaccines for families with young children.  At the time Polio was such a disturbing epidemic that many medical professionals flatly refused to see patients in those wards or with a suspected case.  According to numbers from the Smithsonian Institute as many as 11%  of nurses and doctors working in Polio wards in Los Angeles would contract the condition while treating those with an outbreak.  The push to use the only viable prevention was so huge that one New York City doctor reported giving an estimated 700 vaccines to children in the course of one week.

Polio Vaccine promotional poster from the Smithsonian Institute.

Unfortunately, no vaccine is without risk and the Oral Polio Vaccine (OPV) had some of the worst.  Children with highly compromised immune systems resulted in cases of Paralytic Polio. This is caused by the type of exposure and the use of an attenuated virus* (sometimes called a Live Virus).  Though the virus is intentionally made weaker through a preparation process it will reproduce and begin the pattern of infection to trigger the body's immune system to respond properly and build an effective protection.  As one might guess the risk lies in how some bodies may not provide timely reaction for any number of reasons and will allow the weak but present virus to spread too quickly, thus leaving an infection too large for natural solution and just as risky.

In more than 95% of the population there is no infection and the body develops the immunity as expected.  4 - 4.5% react with a-symptomatic polio which causes no complication and will be fended off in a slower building of immunities.  In the remaining 0.5 - 1% the outcome is no antigen reaction resulting in paralytic polio which may become permanent.

Much of this risk was removed when the second form of vaccine was released a few years later.  The Inactivated Polio Vaccine (IPV) became the standard form of treatment by 1963 and was credited with the eventual removal of the disease from regular outbreaks in the population.  These vaccines use an "inactivated" strain of the virus which has been treated to prevent infection but can result in allergic reaction to the other components (neomycin, streptomycin, and polymyxin B) which are used to keep the virus in stasis while allowing the body to form antigens. 

By 1979 the widely promoted use of vaccines meant that the number of reported cases was small and reduced mainly to those areas where religious law did not allow for the use of vaccinations.  An estimation of ten confirmed cases of Polio through exposure to the wild form of the virus was given as proof of eradication due to the general population's immunity and began the theory and study of herd immunity as a viable method to control disease spread.  

Antibody: A protein found in the blood that is produced in response to foreign substances (e.g. bacteria or viruses) invading the body. Antibodies protect the body from disease by binding to these organisms and destroying them.  

Antigen: Foreign substances (e.g. bacteria or viruses) in the body that are capable of causing disease. The presence of antigens in the body triggers an immune response, usually the production of antibodies.

Attenuated Vaccine: A vaccine in which live virus is weakened through chemical or physical processes in order to produce an immune response without causing the severe effects of the disease.  Attenuated vaccines currently licensed in the United States include measles, mumps, rubella, shingles (herpes zoster), varicella (chicken pox), and yellow fever. Also known as a live vaccine.

Booster shots: Additional doses of a vaccine needed periodically to "boost" the immune system. For example, the tetanus and diphtheria (Td) vaccine which is recommended for adults every ten years.

Community immunity: A situation in which a sufficient proportion of a population is immune to an infectious disease (through vaccination and/or prior illness) to make its spread from person to person unlikely. Even individuals not vaccinated (such as newborns and those with chronic illnesses) are offered some protection because the disease has little opportunity to spread within the community. Also known as herd immunity.

Why I Immunize: Part I

I am a mother who loves science.  I also love my children and do everything in my power to do the best I can by them, including using logical practices to prevent disease and injury.  I also have my own, very real long term health concerns that lend to some difficulty in providing immunity and protection for both my soon-to-be-baby and the toddler.

There are a number of things that can be done to prevent disease without going so far as to place one's child in a bubble and never allow them contact with the outside world.  I follow trends in medicine closely and form my own rules based on what has the highest proven safety rate.  To explain all of the options and give them as much discussion on both sides (pros and cons) they will be broken into topical sections.

 

If this is your work let me know.  I want to credit the artists
because it contains huge amounts of awesome and you deserve credit!

In these entries I plan to cover the most basic forms of prevention and some of the situations where prevention has been ignored to detriment of community health.  From the basics of person hygiene and hand washing, to the controversy of vaccines and epidemics, I believe there should always be open discussion to reach a solution.  Anyone having a topic or supported information that might be interesting to add as an alternative is welcome to submit it for discussion provided that can show credible sources. 

I will refer often to both the Centers for Disease Control (CDC) and American Academy of Pediatrics (AAP) because they provide a great dictionary for easy reference and are responsible for the information a typical pediatric center will provide when asked by parents. 

Please understand that while there is a point to having a dialog about health choices, the spreading of misinformation or admittedly false "facts" is not helpful.  Most notably the infamous claims that vaccines cause autism which were based on intentionally falsified documents do not lend to providing an education for parents.  Discussion about allergies to vaccine components and alternative choices to support good health are very useful and can assist a parent know how to prevent many kinds of undue risk to their child.  Health information from homeopathic sources is wonderful and welcome with verifiable proof such as clinical or otherwise approved trials (many countries require different types of tests).

At the end of my prepared sections I will share some of the home remedies and alternatives to over the counter items that I have found to be safe and successful in my own home.  I cannot promise they will work for everyone, nor that they might not be problematic in terms of allergic reactions which you should always watch for with any new substance.  Many of these are based on herbal medicine and for those interested in it I highly recommend doing your own study on the topic and making a reference library. 

Section One: Hygiene As Prevention

To ease into this, we'll start with the basics, hygiene as prevention. 

MDH poster for the prevention of disease through hygiene.

Washing hands and brushing teeth is so basic we start on these skills with toddlers.  My two year old is so fond of washing hands and baths that he will ask everyone in our house to lift him up so he can use the skin.  I'm not discouraging this behavior, hand washing helps remove exposure to bacteria and viruses we come in contact with through even the safest daily behavior.  

I'm a fan of homemade soaps and it really does help when picking out smells that things like mint and lemon are both naturally anti-bacterial and work without damaging the skin.  When making a hand soap purchase, go for a soap that does not contain perfumes as they often involve a chemical base that can promote headaches and be problematic on sensitive skin.  If you are a fan of organics or shop at farmer's markets but have not found something to be attached to so far, I suggest the awesome soaps from LUSH: Handmade Cosmetics and use their "Sexy Peel" as our hand soap if I am out of my farmer's market goodies.

While we all know hand washing is simple and essential, how often is it actually done and when should we do this?  Yes, I'm going into detail on something we all learned as children because the numbers of people who do not practice the basics is worrying.  To quote the CDC "About 2.2 million children under the age of 5 die each year from diarrheal diseases and pneumonia, the top two killers of young children around the world."

Cholera is a world wide issue and comes from the transfer of contaminated fecal matter the next victim via oral means, large countries have outbreaks due to poor conditions where the virus can hide after feces enters the water supply.  Pinkeye (Conjunctivitis) is an issue because the touching of eyes and face is so common that failure to wash hands between activities can spread infection from both the viral and bacterial agents which create this issue. Salmonella is a risk we are aware of in my home because we have had reptile pets and chickens which may increase the chance of exposure through both skin and eggs.

While these infections can be prevented with hand washing (and proper food prep techniques if you are consuming eggs), there are cases where washing might not be viable at the moment and so we move to the next solution.  Next on the list of typical choices is hand sanitizers.

Most parents know about these little bottles that appear as if by magic at playgrounds and birthday parties when kids show up with sticky hands.  I carry a bottle in my diaper bag and use it after cleaning my hands with a baby wipe post diaper change or dealing with other disgusting messes.  As a temporary fix for exposure to possible contamination, these are wonderful, but there is a downside too.

The problem comes when over use of these products does not always prevent contamination AND can lead to more resistant bacterial strains.  While they serve a purpose in the grand scheme of things, the dependence on such things may also factor in to the resistance of some bacteria to known treatments.  This becomes a more pressing problem when sanitizers are being used as the primary defense in medical settings like hospitals where people who have a lower resistance level will naturally congregate. 

To recap what I said here, the following is a simple list of times to wash hands and how to properly wash them:

When Should You Wash Your Hands:

• Before, during, and after preparing food
• Before eating prepared food
• Before and after caring for someone who is sick
• Before and after treating a cut or wound
• After using the toilet
• After changing diapers or cleaning up a child who has used the toilet
• After blowing your nose, coughing, or sneezing
• After touching an animal, animal feed, or animal waste
• After handling pet food or pet treats
• After touching garbage
  

 How Should You Wash Your Hands:

• Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
• Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.
• Scrub your hands for at least 20 seconds. Need a timer? Hum the "Happy Birthday" song from beginning to end twice.
• Rinse your hands well under clean, running water.
• Dry your hands using a clean towel or air dry them with a blower.