Introduction

Childhood immunizations have saved countless lives and complications suffered by children due to "routine childhood illnesses." Nearly 300 years ago, smallpox would sweep through cities, killing up to 50 percent of infected individuals (CBS News, 2007). At its peak, measles

killed 3,000 children and hospitalized 48,000 annually prior to the availability of the measles vaccine in 1963 (Ouellette, 2007). In 2004, there were 44 reported cases of measles reported in the U.S. (Ouellette). Today, many of the diseases that killed or created permanent medical disabilities are no longer seen or experienced due to childhood immunizations.

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The future of immunizations against childhood diseases is in peril. Missouri Senate Bill 670 seeks to provide "the rules promulgated by the Department of Health and Senior Services regarding the list of immunizations that are required for entry to school and certain child care centers shall not require any immunizations that are not specified under current law and may only modify the manner and frequency of immunizations" (to include ZERO). This issue assumes a high level of priority for health professionals and the public. Already there have been informational hearings regarding the effects of mercury on the body under the guidance of Senator John Loudon. The bill was first read on March 1, 2007, then on March 5, 2007 there was a second read and referral to Seniors, Families and Public Health Committee, and on April 3, 2007 a hearing was conducted with the Seniors, Families and Public Health Committee (Missouri Senate, 2007).

On January 24, 2007, Senator Loudon co-hosted a symposium on the dangers of Thimerosal in vaccines. The consensus was mercury is toxic (Loudon, 2007) and is no longer in state-mandated vaccines but it remains in most flu vaccines. Additionally, the pharmaceutical industry should be encouraged to deliver flu and varicella vaccines without mercury (note: there has never been any thimerosal in varicella vaccines).

Furthermore, when SB 670 wording is reviewed, the suggested changes regarding vaccines are "such rules and regulations may modify the manner and frequency, including "zero" frequency, of the immunizations [that are required of children] which are specified in this subsection. Such rules shall not require immunizations not specified by this subsection." Presently, only polio, rubella, rubeola, mumps, tetanus, pertussis, diphtheria, and hepatitis B are required. By implementing these changes, hepatitis A, meningococcal, haemophilus influenzae type b (Hib), pneumococcal, and varicella will be excluded as required immunizations and the option of "zero" vaccinations may be acceptable.

It is important to note the Committee on Legislative Research Oversight Division indicates the financial impact of this potential bill is indicated as $0 (Committee On Legislative Research, 2007). While implementation of this bill into law will not cost anything to the state at this time, the increased incidence of illness and subsequent disability related to lack of immunizations will add up over time. This will put an increasing strain on an already overburdened health care system. The impact to children and families whose lives are impacted by these diseases and the complications which can occur, including death are difficult to estimate.

Statistics

During the 20th century the Centers for Disease Control (Immunization Action Coalition, 2006) estimated over 8.5 million people died from diseases such as diphtheria (21,053), paralytic polio (16,316), measles (4,000,000), mumps (162,344), rubella (47,745), tetanus (580), Hib (40,000), varicella (4,085,120), and pertussis (200,752). As a result of childhood vaccinations, smallpox, diphtheria, paralytic polio, and congenital rubella syndrome have experienced a 100% decrease in morbidity and Measles, Mumps, Rubella, Tetanus, and Hib have experienced a greater than 94% decrease in morbidity during the 20th Century in the United States alone (Immunization Action Coalition) and 2004 estimated cases of morbidity from the diseases mentioned in the previous paragraph to be less than 844,000 (a 90% reduction).

A Refresher Course on the Mechanism of Immunization

Immunity is the ability of the human body to recognize and eliminate foreign materials, such as microorganisms, which provides protection from infectious diseases. Immunizations stimulate the body's immune system by introducing a harmless form of a disease organism into the body that creates an active immune response similar to acquiring the natural infection but without contracting the disease or its potential complications (Centers for Disease Control and Prevention, 2007). Screening for precautions and contraindications is done prior to vaccination to ensure safety for the individual receiving the vaccination. The most common reaction to vaccination is redness at the injection site, swelling, and mild pain. Without this response the body is not immune and, if exposed, can and often will contract the disease and its related effects.

Present Controversy

Immunizations previously used thimerosal (ethyl mercury) as a preservative and an antibacterial agent. Controversy regarding thimerosal arose when it was suggested there is a relationship between the mercury in thimerosal and autism. The Institutes of Medicine reviewed all studies of thimerosal and concluded there is not enough evidence indicating autism can be caused by thimerosal exposure in childhood vaccines (John Hopkins Bloomberg School of Public Health, 2007; National Autism Association, 2007). Nevertheless, Thimerosal was removed from children's vaccines in 2005 and the only childhood vaccine containing thimerosal (.01%) is Fluzone (influenza).

What Would Happen if We Discontinued Vaccinations

Since their inception, immunizations continue to save countless lives and healthcare dollars associated with vaccine preventable diseases. The present vaccine requirement has generated "herd immunity" against many diseases which in turn protect the few that are not immunized due to religious or medical reasons. Failure to vaccinate will result in a resurgence of diseases presently eradicated in Missouri and create a financial and emotional burden on its residents. The Centers for Disease Control and Prevention's National Immunization Program (2007) suggest that stopping vaccinations would cause 2.7 million deaths worldwide due to measles. Pertussis cases could surge to 10 to 100 times the rates in countries where vaccination rates were sustained and rubella would once again infect pregnant women who would then give birth to babies with congenital rubella syndrome (causes heart defects, cataracts, mental retardation, and deafness in infants). Finally, as many as 330,000 newborns and birth mothers could die due to lack of tetanus vaccination (National Immunization Program, 2007).

Conclusions

Many serious childhood diseases have been eradicated due to childhood immunizations, with thousands of lives being saved and residual health problems eliminated. Many vaccinations are available to the public through programs such as the Vaccines for Children program in Missouri. This program provides immunizations to children under the age of 19 without insurance coverage. No required childhood vaccine contains the preservative thimerosal that was thought to be linked to autism and there is no definite evidence supporting this connection. Presently, there is a movement to do away with immunizations not presently required by Missouri law and to accept a policy of "zero" as acceptable in regard to immunizations. It is important to remember many diseases eradicated in the United States are still endemic in other countries and due to the present global society; it is only a matter of time before these diseases would re-emerge domestically. It is important for nurses and the medical community to continue to advocate for childhood immunizations and contact our legislators expressing our position on childhood immunizations. These actions will save many lives and healthcare dollars being spent on illnesses and diseases which could have been prevented through vaccinations. Immediate and continued action is needed to ensure continued protection of the children of Missouri.

References

CBS News (2007, April 1). Vaccines not immune from critics: Despite societal benefits, vaccines are stirring concern about alleged side effects. Retrieved April 3, 2007, from http://www.cbsnews.com/stories/2007/04/01/sunday.main2635032/shtml

Centers for Disease Control and Prevention (2007). Epidemiology and prevention of vaccine-preventable diseases. Atkinson, W., Hamborsky, J., McIntyre, L., & Wolfe, S. (10th ed.). Washington, DC: Public Health Foundation.

Immunization Action Coalition. (2006). What would happen if we stopped vaccinations. Retrieved January 22, 2007, from http://immunize.org/

John Hopkins Bloomberg School Of Public Health. (2007). Retrieved April 23, 2007, from http://www.vaccinesafety.edu/

Loudon, John. (2007, January 25). Mercury-in-vaccines symposium yields surprising results. Retrieved April 23, 2007, from Missouri Senate Web Site: http://www.senate.mo.gov/07info/members/newsrel/d07/012507.pdf

Missouri Senate. (2007). SB670. Retrieved April 23, 2007, from Missouri Senate Web Site: http://www.senate.mo.gov/07info/pdf-bill/intro/sb670.pdf

National Autism Association. (2007). Thimerosal. Retrieved January 22, 2007, from http://www.nationalautismassociation.org/thimerosal.php

National Immunization Program. (2007). What would happen if we stopped vaccinations. Retrieved May 6, 2007, from Centers for Disease Control and Prevention Web Site: http://www.cdc.gov/nip/publications/fs/gen/WhatIfStop.htm

Ouellette, E. M. (2007). Open letter to parents from Eileen M. Ouellette, M.D., J.D., F.A.A.P., Former President of the American Academy of Pediatrics (2005-2006. Retrieved May 3, 2007, from Immunization Action Coalition Web Site: http://www.immunize.org/reports/report087.asp

Oversight Division. (2007, March 22). Fiscal note: L.R. No: 0978-02, Bill No: SB670. Retrieved April 3, 2007, from Committee on Legislative Research Web Site: http://www.moga.mo.gov/Oversight/OVER07/fishtm/0978-02N.ORG.htm

Lisa Sitler, Sinclair School of Nursing, University of Missouri-Columbia