Immunization Information: The Benefits and The Risks

By Martin G. Myers

Looking for reliable information and answers to your questions about vaccines?

In Immunization Information, Dr. Martin Myers—one of the nation's leading experts on vaccines, infectious diseases, and immunization—describes the benefits and risks related to immunization and the underlying diseases that vaccines prevent.

Understand what's in each vaccine and how they work. Learn about the infections that vaccines prevent and why they remain important today. Know how and why your neighbors' decisions about vaccines can affect you and your family.

Based on science but written in everyday language, Immunization Information helps you distinguish the facts from fiction. It will show you how to identify misinformation, while also showing you how to find reliable, trustworthy information for yourself.

• Language: English
• Publisher: BookBaby
• Release date: Dec 14, 2021
• ISBN: 9781544524122

Book preview

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Contents

Note to Readers

Preface

Part 1

Introduction & Background

Chapter 1

Introduction

Diseases We No Longer See

How This Book Is Organized and My Objectives

Chapter 2

A Short History of the Development of Vaccines to Control Diseases

If the Diseases Are Gone, Why Do My Family and I Still Need All Those Vaccines?

The Diseases That Vaccines Prevent: Then and Now

Chapter 3

Microorganisms, Infections, and Immune Responses

Microorganisms

Infections and Infectious Diseases

How Pathogens Travel

How Rapidly Pathogens Travel

Our Remarkable Immune System

Chapter 4

What Is a Vaccine?

What Should a Vaccine Do?

Teaching the Immune System: How Vaccines Work

Community Immunity

What Is in a Vaccine?

Human Fetal Components of Some Vaccines

Chapter 5

The Development and Use of Vaccines

Vaccine Development, Regulation, and Recommendations

Vaccine Indications and Recommendations

Why Are So Many Childhood Vaccines Recommended for All Children?

Why Not Just Spread the Shots Out a Bit?

Can the Child’s Immune System Handle All Those Vaccines?

Vaccine Adverse Events and Vaccine Side Effects

Chapter 6

Assessing the Risks

Comparing the Risks of Apples and Oranges

Dealing with Numbers

Did a Vaccine Cause That?

Cause or Coincidence

Epidemiology

How to Determine Whether a Vaccine Caused That

Chapter 7

Evaluating Information about Vaccines

Out of Sight, Out of Mind

How Does Misinformation about Vaccines Get Spread So Widely and So Quickly?

An Example of Misinformation and Reemerging Infectious Diseases

Identifying Misinformation about Vaccines

Who Are the Misinformers?

Evaluating Information about Immunizations on the Internet

Part 2

The Diseases Vaccines Prevent

Section I

Beginning to Control Infectious Diseases

Chapter 8

Diphtheria

The Illnesses That C. diphtheriae Cause

Diphtheria Antitoxin

Diphtheria Toxoid Vaccine

Diphtheria Toxoid Vaccine Side Effects

Do I Really Still Need to Worry about Diphtheria?

My Assessment of Risks

Chapter 9

Tetanus

The Illnesses that C. tetani Cause

Tetanus Toxoid Vaccine

Tetanus Toxoid Vaccine Side Effects

Do I Really Still Need to Worry about Tetanus?

My Assessment of Risks

Chapter 10

Whooping Cough (Pertussis)

The Illnesses That B. pertussis Cause

Whooping Cough Vaccines

Whooping Cough Vaccine Side Effects

Do I Really Still Need to Worry about Whooping Cough?

My Assessment of Risks

Section II

Diseases Prevented by Viral Attenuation

Chapter 11

Yellow Fever

The Illnesses That Yellow Fever Virus Causes

Yellow Fever Vaccine

Yellow Fever Live Virus Vaccine Side Effects

Do I Really Still Need to Worry about Yellow Fever?

My Assessment of Risks

Chapter 12

Poliomyelitis

The Illnesses That Polioviruses Cause

Poliovirus Vaccines

Inactivated Poliovirus Vaccine Side Effects

My Assessment of Risks

Chapter 13

Measles

The Illnesses That Measles Virus Causes

Measles Live Virus Vaccine

A Case of Measles in the US Is a Public Health Emergency!

Measles Live Virus Vaccine Side Effects

Do I Really Still Need to Worry about Measles?

My Assessment of Risks

Chapter 14

Rubella

The Illnesses That Rubella Virus Causes

Rubella Live Virus Vaccine

An Initial Immunization Policy Conundrum

Rubella Live Virus Vaccine Side Effects

Do I Really Still Need to Worry about Rubella?

My Assessment of Risks

Chapter 15

Mumps

The Illnesses That Mumps Virus Causes

Mumps Live Virus Vaccine

Mumps Live Virus Vaccine Side Effects

Do I Really Still Need to Worry about Mumps?

My Assessment of Risks

Section III

Varicella Zoster Virus: Chickenpox and Shingles

Chapter 16

Chickenpox (Varicella)

The Initial Illnesses that VZV Causes (Chickenpox)

Chickenpox Live Virus Vaccine

Chickenpox Live Virus Vaccine Side Effects

Do I Really Still Need to Worry about Chickenpox?

My Assessment of Risks

Chapter 17

Shingles (Herpes Zoster)

The Illnesses That Reactivating VZV Causes (Shingles)

Shingles Vaccines

Shingles Subunit Vaccine Side Effects

Do I Really Still Need to Worry about Shingles?

My Assessment of Risks

Section IV

Infectious Diarrhea

Many Pathogens Cause Infectious Diarrhea

Chapter 18

Rotavirus Infections

The Illnesses That Rotaviruses Cause

Live Attenuated Rotavirus Vaccines

Live Attenuated Rotavirus Vaccines Side Effects

Do I Really Still Need to Worry about Rotaviruses?

My Assessment of Risks

Section V

Diseases Caused by Polysaccharide Encapsulated Bacteria

Chapter 19

Haemophilus influenzae Type b (Hib)

The Illnesses That Hib Causes

Hib Vaccines

Hib Conjugate Vaccine Side Effects

Do I Really Still Need to Worry about Hib?

My Assessment of Risks

Chapter 20

Streptococcus pneumoniae

The Illnesses That Pneumococci Cause in Young Children

The Illnesses That Pneumococci Cause in Adults

The Pneumococcal Vaccines

Pneumococcal Vaccines Side Effects

Do I Really Still Need to Worry about Pneumococci?

My Assessment of Risks

Chapter 21

Neisseria meningitidis

The Illnesses That Meningococci Cause

Meningococcal Vaccines

Meningococcal Polysaccharide Conjugate Vaccines Side Effects

Do I Really Still Need to Worry about Meningococcemia?

My Assessment of Risks

Section VI

Infectious Hepatitis

Hepatitis A and B Viruses

Hepatitis C Virus

Hepatitis D and E Viruses

The Illnesses That Hepatitis Viruses Cause

Chapter 22

Hepatitis B

The Illnesses That HBV Causes

Hepatitis B (HepB) Vaccines

Recombinant Hepatitis B Vaccine (HepB) Side Effects

Do I Really Still Need to Worry about Hepatitis B?

My Assessment of Risks

Chapter 23

Hepatitis A

The Illnesses That HAV Causes

Hepatitis A (HepA) Vaccine

Inactivated Hepatitis A Vaccine Side Effects

Do I Really Still Need to Worry about Hepatitis A?

My Assessment of Risks

Section VII

The Human Papillomaviruses

Chapter 24

The Genital HPVs

The Illnesses That Genital HPVs Cause

HPV Vaccines

HPV Vaccines Side Effects

Do I Really Still Need to Worry about the Human Papillomaviruses?

My Assessment of Risks

Section VIII

The Influenza Viruses

Chapter 25

Influenza A and B Infections

Seasonal and Pandemic Influenza

The Illnesses That Influenza Causes

Influenza Vaccines

Influenza Vaccines Side Effects

Do I Really Still Need to Worry about Influenza?

My Assessment of Risks

Section IX

The Coronaviruses

The Human Coronaviruses

Emerging Infectious Disease Pathogens

Animal Coronaviruses as Human Pathogens

Chapter 26

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

The Illnesses That SARS-CoV-2 Causes

Outcomes of Hospitalized Adult Patients

SARS-CoV-2 Vaccines

SARS-CoV-2 Vaccines Side Effects

SARS-CoV-2 mRNA Vaccines Side Effects

SARS-CoV-2 Adenovirus Vaccine Side Effects

Do I Really Still Need to Worry about SARS-CoV-2?

My Assessment of Risks

Part 3

After Words

Chapter 27

Making Vaccine Decisions

Those Who Are Unimmunized May Not Be Exposed to the Pathogen

Those Who Become Infected May Not Have a Terrible Outcome

Vaccines Do Have Side Effects and Some of Them Can Be Serious

Community Immunity Is Important for Everyone

Making Vaccine Decisions

Glossary of Terms

Acknowledgments

Copyright © 2021 Martin G. Myers, MD

All rights reserved.

Immunization Information

The Benefits and The Risks

ISBN  978-1-5445-2411-5 Paperback

            978-1-5445-2412-2 Ebook

Note to Readers

This book contains the opinions and ideas of its author. It is intended to provide helpful information about vaccines and the illnesses they prevent. The reader should consult their healthcare provider for specific questions and advice about immunizations.

The author and publisher specifically disclaim all responsibility for any liability, loss, or risk, personal or otherwise, incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this book.

For you and your family.

Preface

This book is about the vaccines that have been recommended for everyone. Even though we no longer encounter people who have been injured by the infections these vaccines prevent, it is important to understand them because they are all still present and capable of causing harm. My intent is to provide you the information you need to make informed decisions about each of these vaccines. To do that, you need to be able to assess the benefits and the risks of the infections and the vaccines.

To ensure everything you read here is clear, reliable, and understandable, I have had both professional colleagues and groups of parents read the manuscript. I want you to know that all proceeds from the sale of this book are going into a fund to support education about vaccines, I have no financial relationship with any pharmaceutical company, and I am not speaking on behalf of any organization, just myself.

In the first part of this book, I provide the information I think everyone needs to know in order to be able to understand the infections as well as their vaccines, how vaccine decisions are made, and how to evaluate information about vaccines. In the second part of this book, I describe the various illnesses these infections can cause, tell you how each vaccine was developed, list the actual side effects of each vaccine, and explain how each vaccine has altered the occurrence of that infection.

You need to know how likely (or unlikely) it is to be exposed to these infections and what the likelihood of injury would be if infected. Because an encounter with some of these infections now depends on our neighbors’ decisions about vaccines, it has become important to recognize how community immunity (also called herd immunity) affects your likelihood of exposure.

All this is important so that you can balance the benefits and risks of both the infections and the vaccines, which is what making informed decisions about vaccines is all about.

Part 1

Introduction & Background

Why didn’t anyone tell me about this awful disease?

—A Mother’s Question to the Author

Chapter 1

Introduction

Many have questions about vaccines because we no longer see the diseases they prevent. That is because the vaccines work. Because all these infections are still present and capable of causing harm, it is important to understand both the infections and the vaccines.

Diseases We No Longer See

Why would someone write a book about diseases we don’t see anymore? The answer to that important question, of course, is that you still need to know about the diseases that vaccines prevent because all of them, except smallpox, can—and likely will—return.

Many find making vaccine decisions difficult because they are uncertain about the actual risks and benefits of both the diseases and the vaccines. In this book, I address the following questions: what are the infections and illnesses the vaccines prevent? How likely are you or your child to be exposed to those infections? If you become infected, how likely will you be to have one of the more serious outcomes? What are the actual risks of vaccine side effects? Do unimmunized neighbors place you or your child at risk? Additionally, I want you to know how to assess the quality of the information you find elsewhere about vaccines.

Questions I am frequently asked are: do we really need all those vaccines? Does my baby really need that many shots? Are they safe? To answer these questions, you need to understand the infections, the possible outcomes of the infections, what the vaccines’ potential risks as well as benefits are, and how each particular vaccine actually works.

People who delay immunizations risk contracting the infection, but equally important, they can spread the infection in the community, even to some who have been completely immunized. However, that risk differs for each vaccine-preventable disease. That is why we all need to understand the infections, how they are spread, and what the actual risks are if we are exposed to those infections compared to the risks of the vaccines that prevent them.

In the past, everyone knew these diseases because they saw the damage they caused within their families and neighborhoods. Now, many do not know much about them because they don’t see the illnesses or their impacts. They do, however, hear all the time about other illnesses some claim were caused by vaccines—no matter what the experts say.

It is important to understand just how serious the diseases vaccines prevent can be and why you still need to fear them. But it is also essential to understand that developing one of these infections does not mean enduring the most serious outcomes. Also, just because someone is not immunized does not mean they will be exposed to and become infected with a vaccine-preventable disease. For each infection, it is important for you to know why and how the unimmunized can place you and your family at risk.

I began this book after I spoke to a young mother whose child was recovering after a severe infection that could have been prevented by a vaccine. She told the physician caring for her child that she had been confused by the differences in what she heard about vaccines at the clinic compared to what some of her friends said and what she read on the internet. Because she did not know what to do, she did nothing. I asked if she would allow me to tell others about her experience. She started to cry and said, Dr. Myers, why didn’t anyone tell me about this awful disease?

That is a very important question. Because we do not see these diseases anymore, many are unaware of the devastation they are capable of causing—not to everyone but to some. This book is about these infections, the various illnesses they can cause, why people feared them so greatly, how the vaccines were developed, and why we still need to use the vaccines to protect ourselves and our loved ones.

The great irony about vaccines is that because they work, people don’t see the diseases they prevent anymore. They don’t know anyone who was injured by one of these diseases. And we doctors have not been very effective in teaching about the illnesses that vaccines prevent. Indeed, there are now physicians who don’t know much about these diseases either.

The development and use of vaccines has been one of the greatest public health achievements, as important as sanitation and safe drinking water are, for reducing the chances of developing infections and the diseases they cause and improving the lives of countless people. Even though we don’t see these diseases anymore, all are still present and capable of causing injury. For each infection, I will explain why it continues to pose a risk and how it could reappear in the US.

Unfortunately, people often hear about someone who believes they or their child had something bad happen to them after a vaccination, either directly from the person supposedly harmed or indirectly through someone the listener trusts. My first book, Do Vaccines Cause That?!, was meant to help you evaluate vaccine safety concerns; this book is meant to help you understand why the diseases vaccines prevent are still important and dangerous.

People who delay vaccines are important to all of us. Their fear places all of us at risk from some of these vaccine-preventable diseases. These people have told us they are concerned there are too many vaccines, afraid vaccines may cause serious side effects, and worried their child’s immune system might be overwhelmed by vaccines. They don’t think they or their child are at risk for these diseases, and they think these diseases aren’t all that bad anyway. I will address all of these issues, and when I express an opinion that is my own (as opposed to what is established by evidence), I will try to make that very clear.

How This Book Is Organized and My Objectives

To ensure everything you read here is correct, I had colleagues review the accuracy of what I have written. I also had a group of parents and grandparents who have not been medically trained review the content to check that I haven’t used misleading or technical language without explanation. I found out just how important that last group of readers is when I wrote my previous book, Do Vaccines Cause That?! Returning home from a trip, I picked up a manuscript chapter my spouse had been reading for me. She had tried to rewrite whole paragraphs! After talking with her about what she had written, it quickly became obvious how I had confused her. Some of the words I used meant something quite different to each of us. She wisely suggested I add a table of these words and expressions to explain their different meanings. I will include an updated version of that table here. In addition, when I need to use a technical term, I will define it.

Table 1-1. Meanings of Some Technical and Conversational Expressions

Adapted with permission from Myers MG and Pineda D (2008). Do Vaccines Cause That?! I4PH Press, Galveston.

I have not included extensive citations in this book because that would make it difficult to read. I have, however, included references I think are important. And at the end of each chapter, I have included some references to help you locate additional information if you want to read further.

In the first five chapters, I present information about infections and vaccines that I think you need to know: about microorganisms that cause infections, our responses to them, the composition of vaccines, and how public health decisions are made. Because it is so important you are able to locate reliable information about vaccines, Chapters 6 and 7 describe how to find, interpret, and evaluate information about vaccines and the diseases they prevent. Parent readers told me these early chapters (especially 3 and 6) were very helpful for understanding what comes later.

In Part 2 of this book, specific vaccine-preventable infections are discussed within standalone chapters, allowing you to read about all the diseases or just one. I clustered chapters together so I could tell you some of the stories about the diseases and a bit about how the various vaccines were developed and used but also explain the evolution of vaccines and vaccine safety regulations. I have focused on vaccines that are routinely recommended for use in the United States. However, though it is not a standard illness or recommended vaccine in the US, I did include a chapter about yellow fever and its vaccine because of the importance of the yellow fever vaccine to both vaccine development and regulation. I have omitted the descriptions of anthrax, cholera, Ebola, and other infections that US-licensed vaccines can prevent not because they aren’t important but because they are not routinely recommended in the US, where exposure is much less likely than elsewhere in the world. There are also very important infections for which there are exciting new vaccines under development that I will not discuss.

In discussing the side effects of vaccines, I tried to include all that are important for decision-making. For example, I discuss reduced platelets (an important factor in blood clotting) in my description of measles and its vaccine because it is important for you to understand that risk. I have not wasted your time discussing the many poorly understood diseases that some have said vaccines cause if there is no scientific substance to those claims. For example, Guillain-Barré syndrome ¹ (GBS) has rarely been reported after administration of the tetanus vaccine, but analyses of cases through carefully conducted studies could demonstrate no increased risk. I will discuss, however, how those types of studies are done in Chapter 6.

During the course of vaccine development and testing, there were, on occasion, serious mistakes made. I have included a discussion of some of these because those historical mistakes were important for understanding how vaccines are prepared, but more importantly, this discussion explains the regulations introduced to ensure those types of mistakes will not occur again. Because of these oversight rules, the production, delivery, and use of vaccines in the US is one of the most highly regulated industries anywhere, ensuring the routinely administered vaccines in the US are the safest pharmaceutical products available. One colleague of mine, who worked in the pharmaceutical industry, was complaining publicly about the expense and hassle of having to deal with all the US vaccine regulations but then paused to add, But, of course, that is why vaccines produced in the US are considered to be the international gold standard.

I have made no attempt to outline all the different recommendations for administering each vaccine because these recommendations are updated frequently by the Advisory Committee on Immunization Practices (ACIP) and the Centers for Disease Control and Prevention (CDC). In addition, although I do talk about how important vaccines are for certain groups, such as those with various immune-compromising diseases, I have not provided comprehensive information about how to protect them; that would be far more detailed information than possible for this book.

I support the use of these vaccines as recommended by the CDC’s ACIP (and other groups of medical and vaccination experts, like the American Academy of Pediatrics, or AAP, that issue similar guidance). I hope that after reading this book, you will understand why you should as well.

At the end of each disease chapter, I present my personal opinions as to issues I think you still need to consider as well as my assessment of the balance of the risks and benefits of both the vaccines and the illnesses they prevent.

Summary

Because vaccines work, people don’t see the effects of the diseases they prevent anymore. But even though we no longer see these diseases, they are all still present and capable of causing injury.

Some people delay immunizations due to fears surrounding vaccines, which places all of us at risk.

Biomedical scientists need to choose their words carefully because some terms they use can have very different meanings outside of the scientific community.

If You Want to Read More

Allen, Arthur. Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver. New York: W. W. Norton & Company, 2007.

Myers, Martin G., and Diego Pineda. Chapter 3. Missing Information and Technical Jargon: Why Can’t Medical Researchers Talk Normally?! In Do Vaccines Cause That?!, 35–48. Galveston: I4PH Press, 2008.

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1 Guillain-Barré syndrome (GBS) is a disorder in which the immune system attacks nerves, causing muscle paralysis. Fortunately, most people eventually recover.

Public health action to control infectious diseases in the 20th century is based on the 19th century discovery of microorganisms as the cause of many serious diseases . . . Disease control resulted from improvements in sanitation and hygiene, the discovery of antibiotics, and the implementation of universal childhood vaccination programs.

—Centers for Disease Control and Prevention, 1999 ²

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2 Centers for Disease Control and Prevention, Achievements in Public Health, 1900–1999: Control of Infectious Diseases, Morbidity and Mortality Weekly Report 48, no. 29 (July 30, 1999): 621–639.

Chapter 2

A Short History of the Development of Vaccines to Control Diseases

The discovery of microorganisms in the 19th century led to the better understanding of many diseases. Clean water, sanitation, pasteurization, and vaccines—how different things are now!

The 19th century was a period of extraordinary change. It was during this time that scientists finally began to understand the origins of the great plagues and maladies caused by microorganisms, the tiny life forms that could not be seen without magnification. Midcentury, Ferdinand Cohn was able to employ a microscope to see algae and bacteria and then showed he could cultivate them on sterile media. His contemporary, Louis Pasteur, famously disproved the theory of spontaneous generation ³ by preventing microorganisms from contaminating wine. Then, Robert Koch showed that specific diseases were caused by specific microorganisms. For example, he showed that tuberculosis (known at the time as consumption) was caused by the bacterium Mycobacterium tuberculosis. With the recognition that specific microorganisms caused previously mysterious illnesses, it quickly became clear that if the microorganism that caused an illness could be identified, the disease might be understood and possibly even prevented.

The concept of killing the microorganism, or weakening it (called attenuation), preceded Louis Pasteur’s experiments. But he is the one who became famous for showing this could be done to prevent both anthrax and rabies.

Late in the 19th century and throughout the 20th century, many scientists sought to identify, understand, and modify infectious diseases in animals and humans. Advances in microbiology allowed the identification of previously unknown disease causes, many of which were not originally suspected to be infections.

Reproducing the disease through the experimental infection of animals often led to understanding the nature of the disease and, eventually, preventing it. For example, tetanus could be reproduced in animals by injecting the bacterium Clostridium tetani or a bacteria-free filtrate of the medium in which it had been grown. This demonstrated that this specific bacterium produced a toxin (poison) that was the actual cause of the disease. Similarly, diphtheria could be reproduced by injecting toxins produced in the culture fluid from Corynebacterium diphtheriae. Then, the blood of horses that survived these types of infections was shown to be able to neutralize the effects of the specific toxin. Such a horse serum was said to contain an antitoxin. Horse antitoxin was first used to prevent diphtheria in an exposed child in 1891. The first vaccines against diphtheria and tetanus, developed at the beginning of the 20th century, combined the toxins with the antitoxins.

It was also shown that the spread of many diseases could be controlled by preventing exposure to the infecting microorganisms. Many infectious diseases, such as typhoid fever, caused by Salmonella typhi, which is spread in human feces, became uncommon once the water supply was no longer contaminated with human waste and simple improvements in sanitation were implemented, such as prohibiting the disposal of human waste into the street or open areas. Pasteurization (the controlled heating of milk to a temperature that kills bacteria but does not scald the milk) reduced exposure to Brucella spp. (the cause of brucellosis, a disease in animals transmissible to humans through milk), Mycobacterium bovis (the cause of intestinal tuberculosis, also transmitted through milk), and