According to the Centers for Disease Control and Prevention (CDC), measles was considered to have been eradicated in the United States in 2000. But in 2014, the disease made a comeback: The CDC tracked 644 cases. More recently, there was a large outbreak of 380 cases in a religious community in Ohio, where vaccination was opposed. While some parents still question the benefits of vaccinating their children, research has shown that illnesses such as measles, whooping cough, and meningitis are preventable by vaccination.
One such proponent for vaccinations is Nelson Branco, MD, FAAP, a pediatrician at MarinHealth Medical Center. In this podcast, Dr. Branco discusses the benefits of vaccines and when to have them over the course of a lifetime. He also comments on the much-publicized Disneyland measles outbreak as a lesson of what can happen when children and the community at large are not adequately protected from highly contagious diseases.
Selected Podcast
A Shot At Better Health
Featured Speaker:
Learn more about Nelson Branco, MD
Nelson Branco, MD, FAAP
Nelson Branco, MD is a pediatrics specialist and has been practicing for 20 years. He graduated from Boston Univ Sch Of Med in 1995 and specializes in pediatrics.Learn more about Nelson Branco, MD
Transcription:
A Shot At Better Health
Bill Klaproth (Host): Throughout the course of history, vaccinations have played an important part in public health so, what is the social impact of immunizations and the role each plays throughout the lifecycle of infancy, childhood, adolescence and adulthood? Here to talk with us about immunizations and vaccinations is Dr. Nelson Branco, a pediatric medicine specialist at Marin General Hospital. Dr. Branco, thanks for your time. So, through the course of history, vaccines have saved countless lives, is that right?
Nelson Branco, MD, FAAP (Guest): Absolutely there is an interesting article that was published by the CDC, the Centers for Disease Control in 2014 and that was the 20 year anniversary of the vaccines for children program which is the program run by the federal government to ensure that all children get all the recommended childhood vaccines and you know that report looked at the impact of vaccines and they estimated that in the 20 years since that program had begun they had prevented more than 21 million hospitalizations and 732,000 deaths among children born in those twenty years. So, huge impact.
Bill: That’s amazing. And then what is the social impact of immunizations?
Dr. Branco: My family is from a very rural area in Portugal and you know my parents both lost siblings to vaccine preventable diseases when they were young. There are many people here in the Untied States who you know remember the days of polio. I know that my father-in-law and my mother-in-law both had polio when they were growing up and it’s not hard to see that there’s a huge impact in lost lives and you know what we call lost productivity, right. Parents who who can’t work because they have a child who is ill at home, children who can’t attend school and it’s certainly easy to imagine all these children who were affected by vaccine preventable diseases who weren’t able to you know go to school and get jobs and pursue the future that all of us want for our children.
Bill: Right, you never really think of the lost productivity when people are out sick. So, that makes sense. So, can you take us through the role of vaccinations then? Let’s start with infancy.
Dr. Branco: Yeah, so in infancy, is one of those times when we – we give a lot of vaccines because infants are uniquely susceptible to many of the – the diseases that we want to prevent you know things like meningitis, and whooping cough. It’s also a – a time when children are coming to the doctor frequently and so we take advantage of the fact that we are seeing them frequently to get them protected and so in infancy, we vaccinate against things like hepatitis both A and C, whooping cough, polio, meningitis, both haemophilus meningitis and pneumococcal meningitis and then rotavirus, measles, mumps and rubella, chickenpox. All of those things are given by the time the child is fifteen months we often hear is their immune system developed enough to get all of these vaccines and one of the things that I have seen in my own career is we’ve added new vaccines is the huge impact on decreasing disease in these kids, little ones who are getting far fewer ear infections meningitis, which is something that I took care of a lot twenty years ago when I began working as a pediatrician that I haven’t fortunately in many years. And so, though their immune system is, and their defenses are not as well-developed as older kids and adults; vaccines are the best way to protect them because they can handle the antigens in the vaccines much better than they can the actual disease.
Bill: And as a child ages then, how about childhood?
Dr. Branco: So, in childhood, once we get through the infant series, then it really is just doing booster doses in childhood and so I mentioned all the diseases that we protect infants against but one that I didn’t mention would be influenza. Infants are particularly susceptible to the different illnesses you get associated with influenza and so they can get dehydrated and pneumonia and other lung infections, pneumonitis. The child as they get into preschool and school age, they are exposed to things like influenza all the time, so we recommend yearly influenza vaccines. We’ve found that we can keep communities healthy if we keep influenza out of the schools because that’s such a breeding ground for influenza outbreaks. The other vaccines that you get in childhood are – are boosters for your whopping cough, diphtheria and tetanus and boosters for your polio vaccine and that’s pretty much it until you get to your preadolescent – adolescent age range.
Bill: And then what are the vaccinations you give during adolescence?
Dr. Branco: So, in adolescence we continue recommending the influenza vaccine because we want to make sure to keep kids and communities healthy we do a booster dose again of the whopping cough vaccine. Whooping cough is a particularly tricky one because your body doesn’t make very good immunity to either the disease or the vaccine. There’s another booster called the T-Dap that combines. Tetanus and whooping cough and then we start some vaccines that are for illnesses that kids become more susceptible to either due to mostly due to exposure at those ages one is meningococcus which is a bacterium that causes meningitis. So, this is the third vaccine targeted to meningitis but you know three different bacteria and so meningococcus is the adolescent one and then the HPV vaccine which targets the human papilloma virus which causes cervical cancer and head and neck cancer and other cancers.
Bill: And then how about adulthood?
Dr. Branco: In adulthood, there is a recommendation for the shingles vaccine. You know most of us who grew up in the days prior to the chickenpox vaccine are susceptible to shingles because we had chicken pox disease when we were younger. And so, there’s a recommendation for a shingles vaccine there’s also a recommendation for a pneumococcal vaccine. Pneumococcal vaccine or Prevnar is one that we have been using in children for many years. Twenty years ago, I was working in a center that was part of the original vaccine trial for the Prevnar vaccine and it has been used in children very successfully for many years and now it’s been shown to be very effective in older adults in preventing pneumonia. So, shingles vaccines and pneumonia are the two booster vaccines or protective vaccines and then of course the – the yearly flu vaccine which is a good idea for everyone but certainly it’s very encouraged for older adults, because influenza complications are such a huge issue.
Bill: So, it’s a good idea to pay attention to those vaccinations as you get into adulthood as well. And Dr. Branco, there’s a small pocket of people who don’t believe in vaccinations and unfortunately, these people put other people at risk. Can you talk about the antivaxxers for a minute?
Dr. Branco: Yeah, there certainly has been a lot of concern about vaccines. It’s often traced back to the Andrew Wakefield and the MMR vaccine it was a thimerosal controversy. These are all things that – that I’ve had a lot of experience with in my career. You know all of these concerns come from anecdotes and stories of my child were fine, received vaccines and then they developed some issue, some developmental problem. Autism being the one most commonly talked about. And I have a great deal of sympathy for parents who are dealing with kids who are having challenges and who have a difficult time with autism.
I know that when we take those concerns and we take those stories and we apply good science and we look at large numbers of kids who have gotten vaccines or haven’t gotten vaccines or who have gotten vaccines on the delayed schedule versus the standard schedule we have not been able to see a difference. The same thing has happened with thimerosal. we have removed thimerosal which is a mercury containing preservative from vaccines due to concerns about a possible impact and we haven’t seen any change in the twenty years since we’ve done that. we are fortunate in the US that we have a good vaccine system that can survive and thrive without thimerosal so, there is no reason to add it back in but the point is that there’s a lot of fear out there about vaccines and parents are very worried and are listening to voices that aren’t always based on evidence and fact and science.
There’s some sentiment of some grand conspiracy which I think always baffles me as a pediatrician who cares for kids and cares deeply about kids in my community. I find it a little surprising and frankly insulting when I’m told that I’m part of this vast conspiracy and I know many of the people who are vaccine researchers and making good decisions about vaccine based on science. the bottom line is that we know that these vaccine preventable diseases are dangerous and that they are prevalent and when we look at episodes like the Disneyland measles outbreak, it was just another lesson to us that these diseases are still around and if we don’t maintain protection in our communities with vaccines, they do come back and so the impact of the antivaccine movement is that as there are fewer people who are protected, there is more of a potential these diseases to come back and you know someone like me whose been practicing for a few years and has seen kids who have gotten very ill or who have died from meningitis or whooping cough or have had brain damage due to measles vaccine, I don’t really want that in my community and so I will work hard to protect all the kids that I take care of.
Bill: Many of us don’t want that and our communities and these diseases coming back and as you say, the fact is, vaccines work. Immunizations have done so much good over the course of history and eradication of many diseases has been so important and quite frankly, I think many of us take vaccines for granted. So, thank you so much for talking to us today about immunizations and vaccines Dr. Branco. For more information visit www.maringeneral.org, that’s www.maringeneral.org. This is the Healing Podcast brought to you by Marin General Hospital. I’m Bill Klaproth. Thanks for listening.
A Shot At Better Health
Bill Klaproth (Host): Throughout the course of history, vaccinations have played an important part in public health so, what is the social impact of immunizations and the role each plays throughout the lifecycle of infancy, childhood, adolescence and adulthood? Here to talk with us about immunizations and vaccinations is Dr. Nelson Branco, a pediatric medicine specialist at Marin General Hospital. Dr. Branco, thanks for your time. So, through the course of history, vaccines have saved countless lives, is that right?
Nelson Branco, MD, FAAP (Guest): Absolutely there is an interesting article that was published by the CDC, the Centers for Disease Control in 2014 and that was the 20 year anniversary of the vaccines for children program which is the program run by the federal government to ensure that all children get all the recommended childhood vaccines and you know that report looked at the impact of vaccines and they estimated that in the 20 years since that program had begun they had prevented more than 21 million hospitalizations and 732,000 deaths among children born in those twenty years. So, huge impact.
Bill: That’s amazing. And then what is the social impact of immunizations?
Dr. Branco: My family is from a very rural area in Portugal and you know my parents both lost siblings to vaccine preventable diseases when they were young. There are many people here in the Untied States who you know remember the days of polio. I know that my father-in-law and my mother-in-law both had polio when they were growing up and it’s not hard to see that there’s a huge impact in lost lives and you know what we call lost productivity, right. Parents who who can’t work because they have a child who is ill at home, children who can’t attend school and it’s certainly easy to imagine all these children who were affected by vaccine preventable diseases who weren’t able to you know go to school and get jobs and pursue the future that all of us want for our children.
Bill: Right, you never really think of the lost productivity when people are out sick. So, that makes sense. So, can you take us through the role of vaccinations then? Let’s start with infancy.
Dr. Branco: Yeah, so in infancy, is one of those times when we – we give a lot of vaccines because infants are uniquely susceptible to many of the – the diseases that we want to prevent you know things like meningitis, and whooping cough. It’s also a – a time when children are coming to the doctor frequently and so we take advantage of the fact that we are seeing them frequently to get them protected and so in infancy, we vaccinate against things like hepatitis both A and C, whooping cough, polio, meningitis, both haemophilus meningitis and pneumococcal meningitis and then rotavirus, measles, mumps and rubella, chickenpox. All of those things are given by the time the child is fifteen months we often hear is their immune system developed enough to get all of these vaccines and one of the things that I have seen in my own career is we’ve added new vaccines is the huge impact on decreasing disease in these kids, little ones who are getting far fewer ear infections meningitis, which is something that I took care of a lot twenty years ago when I began working as a pediatrician that I haven’t fortunately in many years. And so, though their immune system is, and their defenses are not as well-developed as older kids and adults; vaccines are the best way to protect them because they can handle the antigens in the vaccines much better than they can the actual disease.
Bill: And as a child ages then, how about childhood?
Dr. Branco: So, in childhood, once we get through the infant series, then it really is just doing booster doses in childhood and so I mentioned all the diseases that we protect infants against but one that I didn’t mention would be influenza. Infants are particularly susceptible to the different illnesses you get associated with influenza and so they can get dehydrated and pneumonia and other lung infections, pneumonitis. The child as they get into preschool and school age, they are exposed to things like influenza all the time, so we recommend yearly influenza vaccines. We’ve found that we can keep communities healthy if we keep influenza out of the schools because that’s such a breeding ground for influenza outbreaks. The other vaccines that you get in childhood are – are boosters for your whopping cough, diphtheria and tetanus and boosters for your polio vaccine and that’s pretty much it until you get to your preadolescent – adolescent age range.
Bill: And then what are the vaccinations you give during adolescence?
Dr. Branco: So, in adolescence we continue recommending the influenza vaccine because we want to make sure to keep kids and communities healthy we do a booster dose again of the whopping cough vaccine. Whooping cough is a particularly tricky one because your body doesn’t make very good immunity to either the disease or the vaccine. There’s another booster called the T-Dap that combines. Tetanus and whooping cough and then we start some vaccines that are for illnesses that kids become more susceptible to either due to mostly due to exposure at those ages one is meningococcus which is a bacterium that causes meningitis. So, this is the third vaccine targeted to meningitis but you know three different bacteria and so meningococcus is the adolescent one and then the HPV vaccine which targets the human papilloma virus which causes cervical cancer and head and neck cancer and other cancers.
Bill: And then how about adulthood?
Dr. Branco: In adulthood, there is a recommendation for the shingles vaccine. You know most of us who grew up in the days prior to the chickenpox vaccine are susceptible to shingles because we had chicken pox disease when we were younger. And so, there’s a recommendation for a shingles vaccine there’s also a recommendation for a pneumococcal vaccine. Pneumococcal vaccine or Prevnar is one that we have been using in children for many years. Twenty years ago, I was working in a center that was part of the original vaccine trial for the Prevnar vaccine and it has been used in children very successfully for many years and now it’s been shown to be very effective in older adults in preventing pneumonia. So, shingles vaccines and pneumonia are the two booster vaccines or protective vaccines and then of course the – the yearly flu vaccine which is a good idea for everyone but certainly it’s very encouraged for older adults, because influenza complications are such a huge issue.
Bill: So, it’s a good idea to pay attention to those vaccinations as you get into adulthood as well. And Dr. Branco, there’s a small pocket of people who don’t believe in vaccinations and unfortunately, these people put other people at risk. Can you talk about the antivaxxers for a minute?
Dr. Branco: Yeah, there certainly has been a lot of concern about vaccines. It’s often traced back to the Andrew Wakefield and the MMR vaccine it was a thimerosal controversy. These are all things that – that I’ve had a lot of experience with in my career. You know all of these concerns come from anecdotes and stories of my child were fine, received vaccines and then they developed some issue, some developmental problem. Autism being the one most commonly talked about. And I have a great deal of sympathy for parents who are dealing with kids who are having challenges and who have a difficult time with autism.
I know that when we take those concerns and we take those stories and we apply good science and we look at large numbers of kids who have gotten vaccines or haven’t gotten vaccines or who have gotten vaccines on the delayed schedule versus the standard schedule we have not been able to see a difference. The same thing has happened with thimerosal. we have removed thimerosal which is a mercury containing preservative from vaccines due to concerns about a possible impact and we haven’t seen any change in the twenty years since we’ve done that. we are fortunate in the US that we have a good vaccine system that can survive and thrive without thimerosal so, there is no reason to add it back in but the point is that there’s a lot of fear out there about vaccines and parents are very worried and are listening to voices that aren’t always based on evidence and fact and science.
There’s some sentiment of some grand conspiracy which I think always baffles me as a pediatrician who cares for kids and cares deeply about kids in my community. I find it a little surprising and frankly insulting when I’m told that I’m part of this vast conspiracy and I know many of the people who are vaccine researchers and making good decisions about vaccine based on science. the bottom line is that we know that these vaccine preventable diseases are dangerous and that they are prevalent and when we look at episodes like the Disneyland measles outbreak, it was just another lesson to us that these diseases are still around and if we don’t maintain protection in our communities with vaccines, they do come back and so the impact of the antivaccine movement is that as there are fewer people who are protected, there is more of a potential these diseases to come back and you know someone like me whose been practicing for a few years and has seen kids who have gotten very ill or who have died from meningitis or whooping cough or have had brain damage due to measles vaccine, I don’t really want that in my community and so I will work hard to protect all the kids that I take care of.
Bill: Many of us don’t want that and our communities and these diseases coming back and as you say, the fact is, vaccines work. Immunizations have done so much good over the course of history and eradication of many diseases has been so important and quite frankly, I think many of us take vaccines for granted. So, thank you so much for talking to us today about immunizations and vaccines Dr. Branco. For more information visit www.maringeneral.org, that’s www.maringeneral.org. This is the Healing Podcast brought to you by Marin General Hospital. I’m Bill Klaproth. Thanks for listening.