Monday, March 29, 2010

Not Vaccinating Puts All at Risk (Marin IJ)

Anarchists contend that government is unnecessary and that an ideal society is an unregulated one. While certain formulations of anarchy may seem conceptually attractive, most of us recognize that government plays a useful role in our lives. We understand that while freedom from regulation is appealing, that appeal exists within the confines of a secure existence. Get rid of government and its associated “intrusions” (annoying things like roads, meat inspections, national defense, and national parks) and the state doesn’t seem so unnecessary anymore. I think most people in Marin would agree with this logic. Which is why it is surprising that many of our local residents do not vaccinate their children.

Vaccination efforts during the past century have made certain childhood diseases so rare that they seem like remnants of an uncivilized past. Few of us have actually seen a new case of polio or measles, so it’s easy to be lulled into thinking that these ailments are so antiquated they couldn’t possibly cause trouble again. Unfortunately, this is just not true. The diseases that we vaccinate against are not extinct; they are lurking, waiting for enough people to drop their guard. If you think that I am an alarmist, consider these recent outbreaks: polio in Nigeria, measles in Britain, and whooping cough in Marin County.

So far this year, we’ve seen three cases of whooping cough (also known as pertussis) at a Marin elementary school and four cases of measles in the Bay Area. Fortunately, no one was seriously ill and the Marin children have completed treatment and are back at school. “It was a small and contained outbreak,” says Marin County public health officer, Dr. Fred Schwarz. Nonetheless, these cases should remind us that we aren’t as safe from vaccine preventable diseases as we may think. Pertussis, for instance, is a highly contagious lung infection that can affect both children and adults and classically causes a “whoop” after coughing. In the days before DTP (diptheria-tetanus-pertussis) immunization, pertussis killed thousands of infants every year. Thankfully, with the advent of widespread vaccination, the number of infections declined 99% between the 1930s and the 1980s and the death rate plummeted to single digits by the 1990s. In the last ten years, however, we’ve seen a resurgence of this infant-killer. Nationwide in 2005, there were over 25,000 cases of pertussis reported to the CDC; 21 of these were in Marin County. There are several explanations for pertussis’ comeback, but mostly it can be blamed on under-immunization. The protection afforded by the pertussis vaccine tends to wear off three to five years after vaccination, thus even children who have received the recommended DTaP series (five shots between the ages of 2 months and 6 years) are at risk for contracting the disease later. Because of herd immunity (immunity that occurs when the vaccination of part of the community – or herd – provides protection to unvaccinated individuals) many parents think that their children are protected against pertussis (and other diseases) even if they are not fully vaccinated. Unfortunately, the more parents who believe this and exercise the (personal belief) exemption to mandatory vaccination, the more likely it is that herd immunity will fail. This is why a group of pediatricians in Philadelphia have published a manifesto to those who “absolutely” refuse to immunize: “by not vaccinating your child you are taking selfish advantage of thousands of others who do vaccinate their children ... We feel such an attitude to be self-centered and unacceptable.” These pediatricians would be appalled with vaccination rates in Marin – according to the California Department of Public Health, the Marin County kindergarten immunization rate is 84.7%, significantly below the state rate of 92.1%. And while we have long suspected that un-immunized children are at greater risk of disease, we now have solid evidence of this. Two papers published last year by a team of researchers from Colorado document significantly increased risk of pertussis (twenty-three fold risk) and varicella (nine-fold) in children whose parents refuse these immunizations.

So, what can we do to ward off a further surge in preventable infectious disease? First, we can acknowledge that although autism is a big problem, there is absolutely no evidence that it is caused by vaccines. As you may have heard, the only previous evidence of such a link, a 1998 study published in The Lancet has been retracted by the journal and thoroughly discredited. Says Dr. Clark Hinderleider, of the Marin Immunization Coalition: "A substantial minority of parents—reported as high as 1 in 5—still believe, quite erroneously, that there is a link between vaccines or the preservative thimerosal and autism. This becomes a significant public health problem when this bad information is translated into refusal of childhood immunizations for vaccine-preventable diseases."

Second, parents should realize that by passing on immunizations, they are not getting a free pass for their children – their kids are more likely to get infected with dangerous diseases. Third, we can all (kids and adults) make sure we have our pertussis booster on board. Kids should get a Tdap booster at age 11 to 12 and adults 64 and under can get the same shot in lieu of a tetanus booster.

And finally, we can give thanks to vaccines for making us safer and healthier than we used to be – and realize that like an anarchist who rants against government while sitting in his federally-subsidized apartment, vaccine critics operate within comfortable confines made possible by the very entity they deride.

For more information, visit the Marin Immunization Coalition web site at or email Dr. Hinderleider directly

Disclosure: I have no financial interest in childhood immunizations.

A Real Yawner (Marin IJ)

Last month, during the Vancouverage of the Winter Olympics, I saw a story that made me stop and yawn. Literally. Apparently speed skater Apolo Anton Ohno, the most decorated American Winter Olympic athlete of all time, has a pre-race routine that includes, of all things, robust yawning. Watching Ohno let loose with a jaw-opening yawn, just seconds before one of the biggest moments of his life, not only triggered my own yawn song, but also made me wonder; why do we yawn?

Obviously, people yawn when they are tired, everyone knows that. But does yawning serve any other purpose than to let your dinner guests know that they have over stayed their welcome? Apolo Ohno thinks so. Ohno told Yahoo Sports that yawning makes him feel better, that it “gets the oxygen in and the nerves out." That sounds good, and I hate to contradict an eight-time Olympic medalist, but it’s not completely true. Yawning, as far as we know, does not improve overall oxygen levels, but it does enhance attention and focus. Based on some recent brain-scan studies, yawning increases the activity of a small area of the brain called the precuneus, which plays an important role in spatial orientation, memory and consciousness. Yawning is also thought to help regulate the metabolism of the brain and serve as a means of achieving empathy within a group setting (interestingly, children with autism-spectrum disorders have an impaired ability to contagiously yawn). Thus, not only is a yawn a good way to keep us from falling asleep on the job, it may also serve to help focus oneself for peak performance. Perhaps there are times then, that rather than greeting a colleague’s yawn with a frown, we should take it as a sign that they mean business.

Of course, as is often said, there is such a thing as too much of a good thing. People who yawn too much may be suffering from pathological yawning – triggered by disease or an adverse reaction to medication. Consider a young woman described by Gilles de la Tourette in 1890 who yawned 480 times an hour – eight yawns a minute – which, given that the average yawn lasts 5 to 10 seconds, is just about non-stop yawning. Clearly, this is neither normal nor beneficial. It turns out that this patient (who also suffered from vision loss and seizures) probably had a tumor of the pituitary gland. Abnormal yawning is also associated with severe migraines, clinical depression, and major stroke. People taking anti-depressants, in particular serotonergic ones (SSRIs such as Prozac), can also suffer aggravating salvos of yawning.

Notwithstanding these exceptions, for most of us, yawning is a useful activity. In fact, some experts encourage yawning – even if you are not tired. Sound impossible? It’s not, just fake a half dozen yawns and the real thing will awaken within you. Dr. Andrew Newberg, director of the University of Pennsylvania’s Center for Spirituality and the Mind and the author of How God Changes Your Brain, writes: “My advice is simple. Yawn as many times a day as possible; when you wake up, when you’re confronting a difficult problem at work, when you prepare to go to sleep and whenever you feel anger, anxiety or stress.” So, how about before the biggest race of your life? I asked Dr. Newberg, and this was his advice: “It certainly is not likely to cause a problem for athletes and the evidence suggests that it will help the brain function. Whether this ultimately leads to better performance makes sense, but has not actually been tested.”

It’s an intriguing concept, and if I can stifle my social phobias I might just give it a shot myself. Who knows, it could be contagious.