To Vaccinate or Not to Vaccinate

4 June 2015


Last week, an e-mail popped into our in box calling for voters in California and Vermont to campaign against state laws that will limit the allowable

exemptions from mandatory vaccinations.  Sent by an

organizations called Citizens for Health, the appeal cites

“bodily integrity and personal and domestic sovereignty”,

alluding to some vague potential loss of liberty and

founding constitutional principles.


Notably absent from this appeal is any mention of the responsibilities that necessarily accompany freedom.  What Citizens for Health considers “the essence of American liberty” – the right to refuse an immunization – inherently includes the ability to pose risk to others.  Refusing a vaccination places you at risk for contracting the particular disease.  Once infected, you become a vector for transmission.  You are now a danger to infants, transplant recipients, cancer patients, those living with HIV/AIDS, the elderly, and others with weakened or compromised immune systems.  While you may have the right to place yourself at risk, that right does not extend to posing danger to others.


There is a powerful meme on Facebook that asks “Remember that time you got polio?  Of course not, because your parents had you vaccinated.”  There is no arguing with that sentiment.  The statistics speak for themselves.  The absence of smallpox in our world is a result of what Citizens for Health term “forced medical treatments.”  Perhaps equally troubling is that this freedom from illness is enjoyed because herd immunity is gained via widespread immunization.  Those demanding the right to refuse vaccination rely on others to provide this protection.  There is something perversely shortsighted and selfish in this.  Guaranteeing others the basic liberty we enjoy is an essential aspect of our freedom.  Concentrated self-interest is not.

Ebola is not America's Immediate Threat


The very word strikes fear. A disease with a fatality rate between 50 and 90%, Ebola hemorrhagic fever (EHF) has lept to the world’s consciousness. The situation in Africa is dire, as evidenced by “out of control” pronouncements. This outbreak is a story of two worlds.

Those fighting the disease in Africa face overextended medical systems, shortages of supplies, cultural traditions and mistrust, and unavoidable exposure. Indeed, the international health community has lost several luminaries who succumbed to the disease they have fought for year.

As with any communicable disease, society’s increased mobility poses a danger. Ebola has

traveled to nations that have never before faced this scourge. Some air restrictions are in place, particularly in France and South Africa, but with literally tens of thousands of flights daily, disease can spread virtually anywhere.

The continued spread and mounting death toll poses a threat to civil order and social fabric. Seemingly inexplicable deaths can feed panic. Social stigma further hinders reporting. It has been estimated that only 25% of the cases in Liberia have been reported or identified. With no known cure, the options for treating cases are limited to supportive care locally. Evacuation of EHF patients is prohibitively complex.

The CDC and public health authorities have issued health alerts. Many medical and humanitarian agencies are withdrawing staff from West Africa in light of the difficulties of protecting them from exposure. People who are known to have been exposed or with a high probability of exposure are being monitored, including in the United States. Additionally, the medical community is highly sensitive to the possible danger. Tuesday night a hospital emergency department in Charlotte closed briefly when a patient who had recently travelled to Africa presented with Ebola-like symptoms.

Translocation to the US is a low probability, but it is not impossible. Awareness is critical. Symptoms of AHF resemble those of influenza: general malaise, fever with chills, sore throat, severe headache, weakness, and joint, muscle, and chest pain. The differentiating factor is whether the ill person has travelled to an area experiencing this outbreak, or has been in contact with someone who has. Someone with exposure and symptoms should immediately contact a healthcare provider, preferably telephonically before showing up at the hospital or clinic. This will allow medical personal to prepare and to protect you, others, and themselves.

Meanwhile, back at the ranch…

A more immediate threat to the US population is the remarkable growth of carbapenem-resistant Enterobacteriaceae (CRE). In the US Southeast, CRE infections have increased an average of 100% for each of the past five years. CRE bacteria are resistant to most commonly used antibiotics. The World Health Organization considers CRE "one of the three greatest threats to human health.” CRE bacteria can cause infections in the urinary tract, lungs, blood and other areas. The death rate from CRE infections is nearly 50%.

Healthy people usually do not get CRE infections – they usually happen to patients in hospitals, nursing homes, and other healthcare settings. Patients whose care requires devices like ventilators (breathing machines), urinary (bladder) catheters, or intravenous (vein) catheters, and patients who are taking long courses of certain antibiotics are most at risk for CRE infections. (CDC)

Deeper cleaning of clinical areas and equipment, screening and isolating incoming patients from other facilities, and renewed focus on hand-washing have been found to be effective in reducing CRE infections. And, of course, proper prescribing and use of antibiotics is a key factor in reducing the danger of antibiotic resistant organisms.

#ebola #carbapenemresistantenterobacteriaceae #cre #inectiousdiseasenosocomialinfections

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