Episode Transcript
Alan Helgeson (announcer):
This is the “Health and Wellness” podcast brought to you by Sanford Health. The conversation today is about childhood immunizations and vaccines. Our host is Dr. Joseph Segeleon, vice president medical officer, Sanford Children’s Hospital.
Dr. Jospeh Segeleon (host):
Good afternoon. This is Joe Segeleon, and welcome to a Sanford podcast on childhood immunizations or vaccines. I’m very excited today to talk about this subject that I know has caused some controversy and has been in the news quite a bit in the last couple of years. Vaccines have generated a lot of attention in the past few years, so let’s tackle this important issue so we can shed guidance and clarification and really give our recommendations on science-based guidance. So today, I’m excited I’ve got two great, great experts that are going to add quite a bit to this conversation, and I’ll have them introduce themselves first. So, Andrea, why don’t you go first?
Andrea Polkinghorn:
Yeah, thanks for having me. My name is Andrea Polkinghorn. My background is I’m a nurse and I’m currently the lead immunization strategist for Sanford Health.
Dr. Jospeh Segeleon:
Great. And welcome. It’s good to have you here. And then we also have Dr. Dani Thurtle as well. Dr. Thurtle, why don’t you introduce yourself as well?
Dr. Dani Thurtle:
So, I am a pediatrician. I am boarded in general pediatric medicine as well as pediatric hospital medicine. I also have a special interest in vaccines and immunization, and I co-chair the (Sanford Health) Enterprise Immunization Committee with Andrea.
Dr. Jospeh Segeleon:
So as our audience can tell, we have two experts that have significant experience in childhood vaccines. And so we’ll go ahead and dive in.
I think what we’ll start with is, I know the entire subject of vaccines as a whole is fairly daunting. But for our listeners, maybe if either one of you would like to offer a brief history of vaccines, why are they important both in the United States and in the world for everyone? What is their place in preventive health medicine, and perhaps what have been some of the success stories, or what have we learned and what have we gained from having childhood vaccines?
Dr. Dani Thurtle:
So I guess I can kick it off. Vaccines have been around for a really long time. Actually, the first that we think of is a smallpox vaccine, which was developed in the late 1700s. Our vaccine science has come a really long way. Modern vaccines really started around the 1950s with the polio vaccine. And since then, our technology and our knowledge of viruses and bacteria has really taken off in a way that’s allowed us to create safe and effective vaccines against a wide range of diseases that we see every day.
I think the most impressive worldwide impact is when we can eradicate a disease. So like we did with smallpox in 1980, the CDC and the World Health Organization declared smallpox eradicated, which means you can’t really catch it anymore. It only exists in labs and we’re able to prevent death and hospitalizations in all kinds of settings from that.
Andrea Polkinghorn:
Yeah, so I think Dr. Thurtle outlined it really well. I think the other thing that I’d like to highlight or help people understand is, you know, when we’re vaccinating, we’re not always working to prevent a hundred percent of disease. And there are some side effects, very mild, that are associated or you can get from vaccines. But we see the same thing, and that’s why we developed the vaccine.
So if you think about the complications that came from polio, so people having to be in iron lungs or not being able to walk any longer. I know an adult polio survivor who lives in Brookings and he’s wheelchair bound. Thankfully those are his only complications and that he didn’t have a more severe reaction from that disease. And so everything is a risk versus benefits, but they’re safe and effective, and that’s why we have more vaccines now today than we have in the past.
Dr. Jospeh Segeleon:
Well, thank you. I appreciate that. So I saw Dr. Thurtle brought up smallpox and we certainly, I haven’t seen a case of smallpox in my career and we attribute that success to vaccines. And of course, a vaccine does not work unless it goes into an arm (laugh).
So let’s talk a little bit about other success stories in measles, diphtheria, pertussis. Other things come to mind. So maybe Andrea, maybe you’d be best to talk about that from the standpoint of, are vaccines effective in eradicating organisms from people or from the population in general?
Andrea Polkinghorn:
Yeah, so really it goes down to public health and we need so many people to get vaccinated so that we can prevent the spread of that disease or having like a large outbreak. We have seen great success. So if you go back and look at the data of the incidence of pertussis before the vaccine came out, it was very high. And it’s much, much lower today when you look at the data. So while we still see some cases, we’re not seeing the outbreaks because efficient number of people have been vaccinated to help prevent that from happening. And so when you look at the historical data compared to where we are today, the incidence that these diseases are happening is much less.
The flip side to that is that what they say is vaccines are a victim of their own success. And so people aren’t seeing the diseases as frequently, which leads them potentially to have a feeling that they’re not needed anymore. And that’s just simply not true. These diseases, you know, they occur more frequently or at a higher rate in other parts of the world. And so with international travel, if we loosen up on our immunization right here and people are traveling, if they’re not vaccinated, not only are they susceptible to those diseases, but potentially bring them back and cause an outbreak here.
Dr. Jospeh Segeleon:
Great, thank you. And I, I think we’ll expand upon that point maybe in a couple minutes here because we acknowledge that vaccine rate is in fact declining and we have concerns about decline of that uptake. So we’ll tackle that in just a couple of minutes.
What I’d like to do now for our listeners is I’ll go to Dr. Thurtle. Dr. Thurtle is a pediatrician. So Dr. Thurtle, if you will, for the individuals who may be on the listening end, let’s pretend that you are talking to new parents as they get ready to start their journey in parenthood, recognizing there’s no manual that I know of yet. And so they’re going to their pediatrician. And how would you discuss what does childhood immunizations look like and also influence their decision on how important the immunizations are for the health of their child?
Dr. Dani Thurtle:
Thank you for this opportunity. It’s definitely a really big topic. Anytime you’re letting someone affect the health of your child, it’s a really big decision. So I love that parents are curious about this. Childhood vaccination really starts at birth. We now have two different viruses that we can immunize against in the hospital, including RSV, which you may get in the hospital or shortly afterwards, or the hepatitis B vaccine, which we know is most effective the closer it’s given to birth.
So we try to give within the first few hours of life, childhood vaccinations go through the entirety of childhood up to 17 and 18 years old. And there’s over 17 different viruses or bacteria, depending on how you count, that are recommended for all children to be vaccinated against. The real bulk of those immunizations start at the 2-month visit. And then at the 2-, 4- and 6-month visit, we’ll see quite a few different vaccines. Those are mostly bacteria that cause brain and lung infections and even polio and tetanus and whooping cough are in that batch.
Then kind of scattered throughout the 15-, 18-month and 1-year visit, there’s a few more. And then at 4 years old we do the kindergarten shots. That’s the point at which most people think your traditional childhood vaccines are kind of wrapping up. Then we get into the group of older kid vaccines, which include more whooping cough and things that older children are more susceptible to, such as brain infections, like meningococcal disease.
So I think the important points here are that vaccines are really targeted to the population that is most at risk. So we know young babies are more at risk for some things, and that’s when we vaccinate. And older kids are specifically at risk for different things, so that’s when we vaccinate for those. It’s really targeted at the time and then you have to get quite a few doses of many of those to get a response. So that’s why there’s numerous booster doses.
Dr. Jospeh Segeleon:
Great. And so for those young children that are so vulnerable, what would be the risk if they did not get vaccinated?
Dr. Dani Thurtle:
So the risk really does go up and include death. And I don’t mean to be really morbid and the bearer of such bad news, but we really vaccinate against very serious diseases. Things like pneumococcus you might have heard of, or haemophilus influenza type B. Those are well known to cause very serious blood, brain and lung infections that can kill children in a short period of time.
We’ve seen a significant decrease in death in this age group because of those. Some of them like rotavirus you might know and have more experience with. Children do get diagnosed with rotavirus or vaccinated against rotavirus in the 2-, 4- and 6-month vaccines. That’s been more useful in preventing hospitalizations and like very severe dehydration. So it really runs the gamut of mild to severe. But I don’t want people to discount the importance of these vaccinations. They’re very important and very devastating illnesses.
Andrea Polkinghorn:
Dr. Thurtle, me, myself, I had chickenpox and I think that’s a really good example of a lot of people or a lot of adults today had chickenpox and probably thought, oh, I was uncomfortable for a period of time, but I did just fine. And so can you talk about some of the complications that we saw there, which is why we actually recommend vaccination now, even if somebody was lucky enough just to have that itchy rash when they had the disease in the past?
Dr. Dani Thurtle:
Yeah, so many common childhood illnesses actually have a small percentage of very severe complications. Chickenpox is going to be one of those where you can actually have a devastating brain infection that can cause scarring and seizure disorders later in life. Additionally, if you have a very severe chickenpox infection, it can put you at risk for bacterial infections.
The same thing with measles. Measles has a long-term complication that can cause devastating brain effects and neurological outcomes later in life. So things that people think are really simple illnesses, a small percentage of those do have devastating and severe complications that we can’t prevent, we can’t predict and we can’t reverse. So the safest and best way to prevent those is through vaccination.
Dr. Jospeh Segeleon:
I want to thank both of you for those great comments. As a physician and as a pediatric critical care physician, I was in my training and in my early practice years prior to some of those bacterial vaccines that Dr. Thurtle spoke about had come out. And so I did want to make sure that we pointed out that we don’t want to take it for granted that we don’t see as much of those illnesses because we don’t see it because, in fact, children are vaccinated against those. And so with our rates declining, I wanted to make sure we pointed that out.
I also wanted to comment on something that Andrea said earlier. We now have an RSV vaccine. RSV is the number one cause of hospitalization in children. We have a flu vaccine, which we’ve had for many, many years, and though you may still get the infection, if you are vaccinated, the likelihood that you will get very sick or hospitalized or die is significantly reduced if you’re vaccinated. So I thank you both for pointing out those extremely important points.
Andrea Polkinghorn:
Dr. Segeleon, I like that you touched on flu because I was going to lift that up relative to Dr. Thurtle’s comments. Every year there are on average probably about 150 to 200 children who die from influenza every year. A majority of those are unvaccinated. I think people also tend to think, oh, they’re probably kids with chronic conditions, but the data does not show that. These are completely healthy children who are dying from this disease. And so people who, you know, say that, well, the flu vaccine doesn’t work that well, I don’t want it, kind of what I’ve told them is like, it’s the best defense that we have. And yes, even if it’s only 30 to 60% effective in preventing you from getting sick, that’s still better than zero and it will prevent you from those severe complications like hospitalization and death.
Dr. Jospeh Segeleon:
Yeah, I appreciate that. As an intensive care doc, we’ve all taken care of children who have had severe flu, just like also you reminded me in asking about chickenpox. Prior to the chickenpox vaccine, the secondary pneumonia that kids can get is also extremely virulent. So thank you.
We said at the beginning of the conversation that vaccines have really been in the media quite a bit, and there’s been some, perhaps some unnecessary controversy surrounding vaccines. The unfortunate result of that is that the rates have been declining. So I would like to ask both of our guests perhaps what their opinions might be on why are these rates declining? And then for either of you, what are the consequences of vaccines declining for both an individual and also for the general population?
Dr. Dani Thurtle:
Yeah, I think that what we’ve seen is, especially through the pandemic, we saw a lot of this. That fear is an incredibly powerful motivator for people and how they act and how they protect themselves. Since vaccines are, as you’ve already heard Andrea say, a victim of their own success, fear is no longer on the side of these illnesses to motivate for vaccination. They do cause severe complications and death, and they are things that I think parents should be afraid of. Instead, fear’s on the side of what we see more often, everyday things in our social media feeds, right?
So there are complications to vaccines, just like with any medical treatment that we do. There’s always a risk-benefit analysis. As a pediatrician, for the majority of patients, the risk-benefit analysis is going to come out on the side of the vaccine. But people are going to see more about complications, particularly when you’re surfing social media. So people see more about different conspiracy theories and other considerations. There have been waves of these kinds of things such as in autism and other things going through the news.
These are always debunked with really, really good evidence and studies that again and again have affirmed that vaccines are safe, they’re constantly monitored, they’re constantly reviewed, they are constantly scrutinized. The CDC does a great job with this. So I fully endorse the safety of vaccines. But I think that there is serious fear out there and we know people respond to fear as a motivator.
Dr. Jospeh Segeleon:
I hear the passion in your voice. Andrea, go ahead please.
Andrea Polkinghorn:
So I think it’s important for people to know that vaccine hesitancy isn’t new. There’s a infographic or it was really a cartoon back from when the smallpox vaccine was coming out that essentially tried to tell people that if you accepted the vaccine it would turn you into a cow. I think what has changed since that’s not new is the ability to quickly, effectively, and broadly disseminate misinformation.
So you talk about things like Facebook, that’s absolutely true. But even some of these news articles, like if you saw something, there’s usually buttons below it that you could share it quickly with like 15 other websites. And so that’s something unfortunately that we have to work to overcome. I think the questions are OK. I totally agree with Dr. Thurtle. You know, when you see that information, it can be really alarming. So I think the important thing is that people are following up with their provider to have discussions about what they saw and to get their questions and concerns really addressed or seek credible websites. Some of the opposition groups actually have robust websites that really look credible, but they’re not.
Dr. Jospeh Segeleon:
Great. OK. Well thank you. I heard Dr. Thurtle use the word “fear” a number of times. And I think of fear, and then when it comes to information or misinformation, I naturally go to the word trust. So if I want to get a trusted information source – and Andrea, you appropriately pointed out the myriad of social media that is available to all of us when it comes to childhood vaccines – what should be my trusted source? Where is that information out there that we can advise and guide our listeners so that they can get credible science-backed information that they can trust?
Dr. Dani Thurtle:
I always say that the best source of information is going to be your child’s doctor. And the big reason for this is because they know you and they can respond to specific concerns in the context of your family and your child’s health. So for example, when I was seeing family in clinics, if I had a family who had a history of seizure disorders, then I could focus on the adverse reactions that I thought were most likely for that family. And then we can talk to those very specific concerns that pertain to you in a really methodical and thorough way to answer specific questions. But that’s why the pediatrician is going to be the best source of information.
Outside of that, the CDC has a wealth of websites and information that are really great to look at. They’re really easy to read, full of excellent information and infographics. You hardly have to read anything. It’s all in pictures, but it does address a lot of the concerns and controversies in a really evidence-based way that’s easy to digest. So I also enjoy the CDC. The American Academy of Pediatrics has good information as well, targeted towards families. But where else do you point families to Andrea?
Andrea Polkinghorn:
Probably not as well known, but Vaccinate Your Family has a pretty good website as well. I think the readability of the CDC is probably a little bit better there. That’s honestly my go-to, especially if you don’t have a clinical background. It’s put in into very good layman’s terms for people without that background.
Dr. Jospeh Segeleon:
Well, I appreciate that. I heard primary care physician, I heard some great sites on the CDC and other sites. We discussed some of the misinformation and the fear, and the importance of trust.
Before we go to access to vaccines, I think I did want to just for a moment talk about, as we’ve seen some decline in vaccines, well, every year in the United States we hear about measles outbreak. We look globally, we have seen some resurgence of diseases that we really haven’t seen in quite a while. So I guess I would like one of you to talk about with this misinformation which has resulted in a decreased (immunization) rate. Maybe we can use measles to talk about what’s the danger to both to our population. We hear about schools that have measles outbreaks, et cetera. Andrea, are you willing to tackle this one?
Andrea Polkinghorn:
I absolutely can. So I would say there is a lot of concern for those of us who work in health care or public health about potential measles outbreak due to the decline in childhood immunization rates.
Measles is a very contagious disease and we need about 95% of people to be immunized to prevent the broad spread of that disease. So even if you look at the data and see that we’ve dropped two, that’s like 2%, that’s still a lot because we can’t keep ourselves protected.
We kind of talked about the other parts of the world too, and measles occurs more often there. And so the concern that we have here, although we haven’t seen large outbreaks – I think the last kind of was around that year that there was an outbreak at Disneyland among unvaccinated – is that if we lessen, if we loosen up and drop our immunization rates, that our communities are going to be vulnerable to a measles outbreak, which we absolutely do not want.
Dr. Thurtle, I don’t know if you want to talk about some of the complications of measles?
Dr. Dani Thurtle:
Yeah. So I already kind of mentioned it earlier, but you can definitely get secondary bacterial infections, pneumonias, things like that. But the one that we really worry about is something called subacute sclerosing panencephalitis, which I like to say out loud because it sounds really scary, but it’s essentially a brain deterioration that happens years and years after your original measles infection.
So even if you think you get through the original infection and bounce back OK, there’s always that lifelong risk that you could have a reactivation and deterioration in your brain function later. It’s not uncommon to see rebounds of these. I think there were over 6,000 cases of mumps last year, and that’s over 50 cases of measles in the United States last year. These are things where we used to have zero cases every year. So they are around, you’re exposed to them and like Andrea said, we have to have a large percentage population to be vaccinated in order for everyone to be protected.
Dr. Jospeh Segeleon:
Well, thank you. I appreciate those comments. I think what I would add as well is with respect to whooping cough or pertussis, when you are a young child, until you complete your first three series of pertussis (immunizations), you remain vulnerable. And often when a young infant gets pertussis, it is life-threatening. Pertussis is the same as whooping cough, and they frequently may get it from a grandparent or a parent or an older sibling if they haven’t been immunized.
So we do continue to see pertussis. It is a very, very serious illness in our young children. And so that’s another circumstance where immunizing a general population protects our most vulnerable children. So really in recapping our conversation we had a great conversation about the history of vaccines. The phenomenal success of vaccines have been for our children both globally in the United States.
I appreciate Dr. Thurtle’s walking through that new parent to understand what lays ahead of them for childhood vaccines and the importance of them. We also unfortunately had to discuss why rates may be declining, predominantly because of fear and misinformation.
And the way for us best to combat that is to provide trusted information, to provide trusted resources and of course to have that valuable relationship between primary care provider and patient and family.
So now I’d like to talk a little bit about the logistics. How do we get access to vaccines? Are these given only in annual physical visits or just clinic visits? And perhaps we talk a little bit at the end about the Vaccines for Children program as well.
Andrea Polkinghorn:
Yeah, I can start us off here. So I think the rural nature of our footprint here in the Midwest does cause some access barriers in certain geographic areas. At Sanford, anybody can walk in a primary care clinic for a vaccine to get updated. I think what Dr. Thurtle kind of talked about earlier though is as children age, you know, they can talk to us and tell us if they aren’t feeling well. We do see those annual wellness exams start to decline at about 15, 18 months. And in particular she talked about kind of those sixth graders around 11 to 12 years. So we’ve been doing a lot of work to incorporate vaccines into things like sports physicals, or even better yet, educating the public that if they’re overdue for annual wellness exam to schedule it that way and the sports physical can be completed as part of that visit.
Along with updating immunizations, I know that our pediatricians really value the annual wellness exams because they’re looking for appropriate growth and development things that might not be caught as easily. I know my daughter’s pediatrician actually caught a small curve in her spine that had we not had that annual wellness exam, I wouldn’t have known at all. So they’re super important.
Dr. Dani Thurtle:
So we always do them at well child visits, we’ll always look at what you’ve had and what you need and what you’re due for. So that’s the best place to do them.
There’s other places to get them though, especially if you live far away from your primary pediatrician, as we know many people do. There are community health clinics or county health clinics. Sometimes the state has some health clinics out there. So there’s usually a very close place to you to get these vaccines.
Dr. Jospeh Segeleon:
Well, Andrea, I wonder if you could talk to us a little bit about the VFC program or Vaccines for Children.
Andrea Polkinghorn:
Yes. So the Vaccines for Children program, there was concerns, I think it was in the 1990s sometime about the risk for children without insurance to potentially, essentially the parents would not vaccinate them because they don’t have insurance. And therefore, again, our communities would be vulnerable to outbreaks of these diseases. And so the government funded a program called the Vaccines for Children program. So essentially the government is providing vaccines for children. This is through 18 years to any VFC-enrolled provider, for example. I think this is done very widespread.
All of our Sanford primary care clinics participate in this program, but it would provide any routinely recommended vaccine for a child at no cost to them. They can charge an administration fee, but if the person is not able to pay the administration fee, it must be waived. So you can always visit the Department of Health website no matter what state you’re in to identify if your local clinic participates in it. But again, it’s really well known, and I would say most health care providers or clinics who are caring for children participate in this program.
Dr. Jospeh Segeleon:
Thank you. I appreciate that. And the bottom line is that finances are not an impediment to vaccinating your child.
Andrea Polkinghorn:
Exactly.
Dr. Jospeh Segeleon:
Great. Well, I think we’ll go ahead and wrap up here. I want to thank my two guests, Dr. Dani Thurtle and Andrea Polkinghorn, for their expertise and their conversation on this very important issue. We continue to try to be a valuable resource and insight for our consumers to give them the most trusted information and to try to, with the goal of the best health care outcomes for our children.
Alan Helgeson (announcer):
Sanford Health has information about immunizations for all ages at sanfordhealth.org. This podcast is part of the “Health and Wellness” series by Sanford Health. For additional podcast series by Sanford Health, find us on App.
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Posted In Children's, Family Medicine, General, Health Information, Healthy Living, Immunizations
