When I started my career as a public health nurse in 1987, we immunized children to protect them from seven infections: diphtheria, tetanus, pertussis, polio, measles, mumps and bubella. Between two months and five years of age, a child would receive six injections and five oral medications (11 total doses) to protect them from infections that in 1950 caused over 4,200 deaths in the United States.
By 1987, the number of deaths in the U.S. from those diseases dropped to only 22, and we had already stopped giving smallpox vaccine, because the disease was eradicated from the planet. Vaccines were viewed as "miracle working" substances, something health care providers and parents could use to protect our children from illness and death. We had first-hand experience with those infections and didn't want to expose our children to them. In 1987 it was rare to have a parent refuse or delay vaccination. Because parents immunized their children, the U.S. was able to declare measles, rubella and polio transmission eradicated.
Since 1987, we doubled the number of diseases that can be prevented through the use of routine childhood vaccines to 14, to include two kinds of bacterial meningitis, Hepatitis A and B, chickenpox, rotavirus infant diarrhea and influenza. Health care providers see these as tools to keep patients healthy, and public health has more tools to prevent disease and disability.
But some parents are pushing back, delaying or refusing to have their child immunized. Parents fear the vaccine more than the illness it was developed to prevent. They depend on a variety of information sources beyond their doctor, who has a limited amount of time to discuss all the health issues for their child. This time limitation has health care providers agreeing to the delay, to the detriment of public health.
So why does public health care if parents make decisions not to immunize their children or to delay immunization? Vaccination works in two ways. First, it protects the person who receives the vaccine from contracting that disease. But second, and more important, the more people in a community who have the vaccine, the less likely it is that the infection will spread. This is called herd immunity.
Herd immunity protects individuals in the community who can't be immunized. That loss of herd immunity puts anyone with an illness that prevents them from being immunized at risk for infection and those are the individuals at most risk for complications and death from vaccine preventable diseases.
A measure used by public health to assess immunization status is the percentage of children who complete their primary immunization series by age 2, with the goal being 90 percent. Completion rates for Manitowoc County 2-year-olds in the last five years have ranged from a low of 79.5 percent in 2010 to a high of 84 percent in 2012. In 2014, the rate declined to 80 percent, far below the desired 90 percent. We do much better for school-aged children who are vaccinated, averaging 95.4 percent over the last five years.
Manitowoc County Health Department immunizes the children we can, those on Badger Care or without insurance coverage for vaccines. We send reminders to the parents of children up to age 3, encouraging them to contact their health care provider to schedule an appointment for missing immunizations. We communicate with parents who have not started immunizations, providing information on the importance of vaccination for their children.
When all efforts to assure vaccination fail and someone gets a vaccine preventable disease like measles or pertussis, we implement public health measures to protect the community ― we isolate suspect and confirmed cases, we quarantine those exposed and at risk for infecting others and we arrange for treatment or vaccination when needed. And then we hope that no one experiences long-term health consequences from a preventable disease.
Amy Wergin is Manitowoc County Public Health Officer.