Current public opinion about childhood vaccinations sometimes seems to be influenced less by science and more by Jenny McCarthy. But here's something that rarely gets discussed: the threat posed by the nonvaccinated to children who are immunosuppressed. Last year, while searching for child care for our 2-and-a-half-year-old son, my husband and I thought we had we found the perfect arrangement: an experienced home day care provider whose house was an inviting den of toddler industriousness. Under her magical hand, children drifted calmly and happily from the bubble station to the fairy garden to the bunnies and the trucks, an orchestrated preschool utopia. But when I asked: "Are any of the children here unvaccinated?" the hope of my son's perfect day care experience burnt to a little crisp. As it turned out, one child had a philosophical or religious exemption—a convenient, cover-all exemption that many doctors grant, no questions asked, when a parent requests one. (I still do not understand how the state can allow one to attribute his or her fear of vaccines and their unproven dangers to religion or philosophy. But that's a question for another day.)
Ordinarily I wouldn't question others' parenting choices. But the problem is literally one of live or don't live. While that parent chose not to vaccinate her child for what she likely considers well-founded reasons, she is putting other children at risk. In this instance, the child at risk was my son. He has leukemia.
What does any of this have to do with vaccinations? While the purpose of chemotherapy is to kill the cancer, it also kills the good cells—most notably the infection-fighting white blood cells. That means my son has limited ability to fight off anything. A single unimmunized child in an ordinary child care setting is the equivalent of a toddler time bomb to him.
So while this nonvaccinated cancer-free child (and I'm sure she is a lovely child!) enjoys a normal white blood count of anywhere between 5,000 to 10,000 on any given day, my son is lucky if his ever breaks 2,000. An ordinary virus or some other seemingly trivial illness can cause his white count to plummet to zero—"the big egg," as one of his oncologists describes it. A fever over 101 degrees earns him a couple of nights in the hospital. On top of all that, his chemotherapy—a bewildering array of pills, IV treatments, and spinal injections—prevents his own vaccinations from working, so he cannot be vaccinated at all in treatment. My son, like other children in treatment for cancers and HIV, is "medically exempt" from being vaccinated while in treatment. In fact, most children with cancer will have to be completely revaccinated when they finish their chemotherapy, because the treatment often wipes out any immunity they may have achieved from their pre-cancer vaccines.
According to Paul Offit, the chief of the infectious diseases division at Children's Hospital of Philadelphia and author of Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure, the danger that nonvaccinated children pose to immunocompromised children couldn't be clearer. Those who cannot be vaccinated, including young babies, transplant, and cancer patients, depend on the immunity of the herd to protect them. In recent years, in communities where many parents opt out of vaccinating their children, the herd has diminished. As a result, unvaccinated children have died from totally preventable infectious diseases such as measles, meningitis, and pertussis.
In 2008 in San Diego, a 7-year-old boy whose parents refused vaccines contracted measles while on a family trip to Switzerland. Before realizing how sick he was, the boy went to school and infected four other kids at school, after having already infected his two siblings. He then infected four other children who happened to be in the waiting room at his pediatrician's office. Three of those children were too young to have received their MMR vaccines. One of those infants was hospitalized; another traveled on an airplane while infectious. This case is a sobering example of how one family's decision not to vaccinate their children has serious consequences for other children.
But it isn't as sobering as the case in January in Minnesota in which an Hib meningitis outbreak severely sickened four children and killed one infant. Of those five children, one was too young to be vaccinated, one had an immune deficiency, and the other three had parents who refused the vaccine. The child who died was among those three children whose parents, out of fear or personal belief, opted out of the vaccine.
A study released this year in the journal Pediatrics demonstrated that children whose parents refused the pertussis vaccination were at a much higher risk of contracting the disease in spite of being surrounded by vaccinated children. In the case of pertussis, also called whooping cough, herd immunity does not even seem to protect the nonvaccinated, which means vaccination is the only option for protection against pertussis. Pertussis can be fatal to infants and the immunocompromised if it is not diagnosed in time to complete antibiotic therapy. My son's own pediatric oncologist noted the danger pertussis could pose to him as the No. 1 reason to seek a fully vaccinated daycare.
I realize that anti-vaccine sentiment has been around as long as the vaccines themselves. People who choose not to immunize their children may do so out of the best possible motives: They believe those vaccines endanger their children. But I wonder whether they have fully considered that the herd immunity, of which they are taking advantage, is designed to protect those who cannot be vaccinated. As a result, my son will not be able to attend a day care that would have been magical for him.
For now, we will hire an at-home sitter for him. It's more expensive and not what we had wanted, but it's the best, safest option. When he is ready to go off to school, we will have to face this issue again: Public schools are forced to enroll unvaccinated children who have religious or philosophical exemptions—again, whatever that means. Because we want him to have as "normal" a life as possible, we'll likely send him off in the bright yellow school bus and cross our fingers that the kid sitting next to him didn't just attend a "chicken pox party" over the weekend. Because what's "just a case of chicken pox" for that kid could be a matter of life or death for mine.