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Running head: SKIPPING VACCINATIONS 1

The Harm of Skipping Vaccinations

Carrie Hallihan

Ferris State University

SKIPPING VACCINATIONS 2

Abstract

In society, there are many health risks that are occurring within different populations that

compromise health, wellbeing, and everyday life. The United States is combating these risks

with one program called Healthy People 2020. This program focuses on health promotion and

disease prevention. Many of the health risks of today’s populations are addressed here, including

immunizations and infectious disease. Acting as an advocate for this program, a goal for a nurse

working within a community or public setting is to educate, inform, and improve the health of

those not vaccinated. It’s important to address the factors that contribute to this risk as well as

statistical data that supports this claim from local, state, and national levels. A consequence from

lack of immunizations can lead to many health concerns. A major concern at the end of 2014

into 2015 was the outbreak of measles. It’s important to evaluate and address how things could

be improved via the health care system and nursing regarding this matter. There are always

things that can be done to help prevent an outbreak. Knowledge is power and that’s where health

care providers step in to address with the community. All of this will be addressed further.


The Harm of Skipping Vaccinations

Health promotion and disease prevention are two of the most important things that health

care workers can be involved with when working in a community or public health setting. In

today’s society, there are so many communicable diseases that have devastating effects on

people. One area of concern or considered an “at risk population” are those that are

unvaccinated or not up to date with their immunizations. The immunization schedule covers

from birth through 18 years of age. It touches many ethnicities and cultures.

There are many diseases that were prevalent in the United States and around the world

that now can be kept under better control with the use of vaccinations. So many lives were lost

when vaccines were not available. Some of those diseases include measles, polio, pertussis,

diphtheria, rubella, mumps, and more. Over the years, thanks to vaccines, many lives have been

saved and many cases of disease have been prevented. “According to a large historical study by

the Centers for Disease Control and Prevention released in November 2007, death rates for 13

diseases that can be prevented by childhood vaccinations were at all-time lows in the United

States” (McNeil, 2008, pg1). Diseases like small pox and diphtheria are rarely seen in the

United States due in part to vaccines being given.

Opposition to vaccinations has been present since vaccines became available before the

late 1800’s. There are many reasons for the opposition of vaccines today. One of the debates

today comes down to this: “as diseases have disappeared, generations have grown up without

ever seeing sickness and death they caused. At the same time, new parents are often upset as

their babies receive between 20 and 30 injections before age 2” (McNeil, 2008). Some suggest

the vaccinations cause more harm than good. “25% believed that their child’s immune system

could become weakened as a result of too many immunizations, and 23% believed that children


get more immunizations than are good for them” (Gellin, Maibach, Marcuse, 2000). Then there

is the scare of immunizations causing autism, though currently there have been many studies

done that show no correlation between the two. “There is no scientific evidence that the measles,

mumps, and rubella (MMR) vaccine or the mercury preservative used in some vaccines plays

any part in the aetiology or triggering of autism, even in a subgroup of children with the

condition” (Taylor, 2006, p. 511). Last but not least, there are those that believe the

pharmaceutical companies cannot be trusted and are just out to make financial gain.

Encouraging immunizations are considered an example of primary prevention and “this

approach protects individual people and populations from getting communicable diseases or

lessons the severity of the disease” (Harkness & DeMarco, 2012, pg. 71). Some factors or

attitudes that can cause vulnerability to the population that is against immunizations would

include religious preference, backlash towards government control, fear of developing autism,

and concern with harmful chemicals being placed in the vaccines just to name a few. Places at

risk would be high populated areas where a person who hasn’t been vaccinated would congregate

(amusement parks, malls, colleges, churches, stores, etc.). Another place at risk would be low

income poverty areas where people aren’t vaccinated, as evidence by third world countries

having high outbreak of disease. Also, unclean areas like Chicago or New York that have a great

deal of trash and things on the street that let rodents, flies, and etc. congregate and breed are

areas of concern.

A possible bias towards why some chose not to vaccinate include what one person calls

“omission bias.” “With vaccinations, choosing to vaccinate is an action – it involves a deliberate

intervention on your child. In contrast, having a child fall prey to an illness that could have been

prevented results from an omission, the failure to vaccinate. The action/omission distinction is


subtle, and it might seem irrelevant here: Surely, the relevant question to ask, in choosing to

vaccinate, is whether the risk of the vaccine (typically very, very low) is higher or lower than the

risk of the disease (typically much higher)” (Lombrozo, 2015). Many in today’s society view the

actual vaccines as harmful, containing potent chemicals. Everyone views the risks differently

and everyone has different beliefs, which leads us to the great debate of whether to receive

immunizations or not. Now that we have some history behind vaccines, let’s take a closer look

at some statistical data at the local, state, and national levels.

Demographics

If we take a closer look at Montcalm County, Michigan for example, data shows that

77% of infants (19-35 months) were fully immunized. Compare that to 66% that were fully

immunized in Michigan, based off the MCIR Immunization Profile Report (Community Health,

2011, pg 6). When we look at the national vaccination coverage for 2011, we see that from

“2010 to 2011, the national vaccination coverage increased from 66.8% to 80.4% for the full

series of Hib, from 64.1% to 68.6% for the birth dose of HepB, from 49.7% to 52.2% for ≥2

doses of HepA, and from 59.2% to 67.3% for rotavirus vaccine” (National, State, and Local Area

Vaccinations, 2012). We can see from these statistics that there is room for improvement on

those receiving vaccinations, while some remain skeptical. The most recent data provided by the

CDC regarding national statistics is from 2013. The 2013 National Immunization Survey of

children 19-35 months states that “nationally, vaccination rates are high, but some communities

remain at risk” (Childhood Immunization Coverage, 2013). Another area of concern is those

who live in low poverty areas. Low income, parents not working, and economic disturbance can

create an environment where child vaccines are the least concern on people’s minds. “In 2013,

children living below the poverty line had lower coverage for several vaccines” (Childhood


Immunization Coverage, 2013). Areas for improvement suggested by this survey include

increasing the number of infants receiving the MMR vaccine and having the toddler vaccine

series completely finished (some adults opt out of completing all of the child’s vaccines needed

through their second year of life). What we do know is that those who choose not to vaccinate

their children make communities vulnerable to communicable diseases.

Health Concerns

There are some health concerns regarding the population that are not vaccinated or have

not received their immunizations per their choice or their parent’s. First, they can spread

communicable diseases more easily since they have not received the vaccinations to help ward

off these diseases (measles, mumps, rubella, pertussis, etc.). Unvaccinated young children are

most at risk, followed by unvaccinated pregnant women. “In countries with high rates of

vaccination against pertussis, the incidence of this disease has decreased dramatically compared

with the prevaccine era. However, pertussis still occurs in these countries, and severe morbidity

and mortality are greatest among infants, particularly those who are unimmunized or

incompletely immunized” (Greenberg, 2005, pp S39). Diseases like measles, which were on

their way out of this country many years ago due to populations being strongly vaccinated are

now making news today because the disease is being brought in from other countries. Secondly,

a person that was not vaccinated for the disease comes in contact with it and then is a susceptible

to spreading it to others within the community. The diseases wouldn’t spread so easily if people

were compliant with vaccinations. Thirdly, coming into contact with these serious

communicable diseases could become life threatening where lives are lost if the right medical

care is not received. What parents may not come to realize or put a strong emphasis on is the

fact that not only are they putting their children’s health at risk, but they are also putting other’s


health at risk. For many (infants), they don’t have a choice at the time because they are so young

and the parents make the choice to vaccinate for them. It is very important to understand what

effects not receiving immunizations can have on people. One of the things our country fears

most is having an outbreak of some sort because our country is so heavily populated and being

able to contain the problem then becomes a challenge.

Measles

One prevalent disease that has been making a comeback in our country is measles. This

is due in part to the fact of people traveling in and out of the country or the unvaccinated

population. There is a table within the appendix below that comes from the CDC weekly report

showing mortality/morbidity of measles from 2010 to 2015. This table lists the number of cases

that occur and one can clearly see that the number of measles cases is on the rise. To combat

this, there is a vaccine called the MMR (Measles, Mumps, Rubella) that babies receive at an

early age which helps prevent someone from coming into contact with the disease because it is

extremely contagious. “In 2013, there were 17 states that had MMR coverage below 90% and

these states are at higher risk for measles outbreaks” (Childhood Immunization Coverage, 2013).

The World Health Organization states that one of the first signs of measles is a high fever

with a possible runny nose, cough, red eyes, and then eventually a rash develops. The rash

spreads over about three days on the body. It can be spread to others through sneezing,

coughing, and live up to two hours on surfaces or in air. Deaths usually occur from

complications to measles and seem to be more common in children under 5 years of age or adults

over 20 years of age. Complications that can occur include encephalitis, severe diarrhea with

dehydration, blindness, ear infections, and even pneumonia can develop (Measles, 2015).


At the end of 2014, there was an outbreak of measles that occurred in California that got

everyone’s attention from media coverage, health officials, and the country. It was a serious

matter that put people at risk. “On January 5, 2015, the California Department of Public Health

(CDPH) was notified about a suspected measles case. The patient was a hospitalized,

unvaccinated child, age 11 years with rash onset on December 28. The only notable travel

history during the exposure period was a visit to one of two adjacent Disney theme parks located

in Orange County, California. On the same day, CDPH received reports of four additional

suspected measles cases in California residents and two in Utah residents, all of whom reported

visiting one or both Disney theme parks during December 17-20. As of February 11, a total of

125 measles cases with rash occurring December 28, 2014 to February 8, 2015, had been

confirmed in U.S. residents connected with this outbreak” (Measles Outbreak, 2015).

What is interesting about this is how extremely quick the disease can spread by simply

one person (who was unvaccinated) and it occurred in a heavily populated area; a theme park.

Closer investigation reveals that “among the 110 California patients, 49 (45%) were

unvaccinated. The patient range in age from 6 weeks to 70 years old” (Measles Outbreak, 2015).

What is important to note here is that some of the patients had been vaccinated but just one

person who was unvaccinated can cause vulnerability within a high populated area very quickly.

The recent outbreak of measles is a reminder that communicable diseases are out there

and there is higher risk to becoming ill with these diseases when there is a population that

chooses not to vaccinate their children or chose not to be vaccinated as adults. Knowing this, the

health care professionals, medical staff, and health care delivery system need to continue

stressing the importance of vaccinations, empowering the minds of the communities, and

encouraging society to think about the health of the ones they love. As we move forward, health


care professionals (doctors, nurse practitioners, nurses, etc.) can improve the health care delivery

system of immunizing the community by assessing immunization status at every visit,

recommend needed vaccines, educating the importance of vaccines and how they benefit the

population, send reminders of when vaccines are due, use electronic medical records to improve

care, and provide written and online resources from the CDC website (for those that have

internet access) Free educational seminars, health fairs, or weekend teaching could take place at

the community level by health care professionals. Immunizations are considered primary

prevention in health care and nurses can play an important role here. Nurses who actively

participate in the immunizations of children in well-child clinics, young adults in university

health clinics, and adults in international travel clinics are promoting primary prevention of

measles, HPV, and yellow fever, respectively (Harkness & DeMarco, 2012, pg 71). Nurses can

also educate the family when they come in for appointments, make sure parents are aware of the

immunization schedule as some vaccines are given more than once, and help to correct

misconceptions that parents may have. Attention to detail is important when it comes to

immunizations so nurses can also make sure that immunization records are accurate and up to

date.

Conclusion

Communicable diseases at one time were thought to be under control and less heard of in

the communities. Today they are making a comeback due to many factors explained above. The

diseases are serious and not something to take lightly. If not treated properly, they can be life

threatening. Immunizations were put into place to help fight against these communicable

diseases, with the thought process being those who received the immunizations would be less

likely to get the disease or spread it. We vaccinate to protect the lives of those we love. Though,


there is a population that exists that chooses not to get the recommended immunizations or

vaccinate their children. This population puts many at heath risk in our society. We as health

care providers need to address the misconceptions that easily decrease their confidence in the

benefits of immunizations. One thing is for certain, immunizations are one of the biggest

controversial topics today. It leaves us with a thought to ponder. Is there more harm and risk to

our loved ones because they acquired the vaccinations than the disease preventing benefits they

are receiving from them?


References

Center for Disease Control and Prevention. (2013). Childhood Immunization Coverage

Infographic: Infant Vaccination Rates High, Unvaccinated Still Vulnerable. Retrieved

from http://www.cdc.gov/vaccines/imz-managers/coverage/nis/child/infographic-

2013.html

Mid-Michigan District Health Department. (2011). Community Health Assessment Montcalm

County Profile 2011. Retrieved from http://www.mmdhd.org/cha/montcalm/

cha_montcalm_ co_profile.pdf

Gellin, B.G., Maibach, E.W., Marcuse, E.K. (2000). Do Parents Understand Immunizations? A

National Telephone Survey. Pediatrics: Official Journal of the American Academy of

Pediatrics. Retrieved from http://pediatrics.aappublications.org/content/106/5/1097.short

Greenberg, D.P. (2005, May). Health Burden of Pertussis in Infants and Children. The Pediatric

Infectious Disease Journal. 24(5), ppS39-S43.

Harkness, G. & De Marco, R. (2012). Community and public health nursing: Evidence

for practice. Philadelphia: Lippincott Williams & Wilkins, pg 71.

Lombrozo, T. (2015). Psychological Biases Play A Part In Vaccination Decisions. NPR.org.

Retrieved from http://www.npr.org/blogs/13.7/2015/02/09/384877284/psychological-

biases-play-a-part-in-vaccination-decisions

McNeil, D.G. (2008, March 28). A multitude of vaccine benefits, yet controversy persists. The

New York Times. Retrieved from http://www.nytimes.com/ref/health/healthguide/esn-

vaccinations-ess.html, pg 1

Measles Outbreak – California, December 2014 – February 2015. (2015, February 20). MMWR:

Morbidity and Mortality Weekly Report, 64(06); 153-154. Retrieved from

http://www.nytimes.com/ref/health/healthguide/esn-vaccinations-ess.html

http://www.nytimes.com/ref/health/healthguide/esn-vaccinations-ess.html

http://www.npr.org/blogs/13.7/2015/02/09/384877284/psychological-biases-play-a-part-in-vaccination-decisions

http://www.npr.org/blogs/13.7/2015/02/09/384877284/psychological-biases-play-a-part-in-vaccination-decisions

http://pediatrics.aappublications.org/content/106/5/1097.short

http://www.mmdhd.org/cha/montcalm/%20cha_montcalm_%20co_profile.pdf

http://www.mmdhd.org/cha/montcalm/%20cha_montcalm_%20co_profile.pdf

http://www.cdc.gov/vaccines/imz-managers/coverage/nis/child/infographic-%092013.html

http://www.cdc.gov/vaccines/imz-managers/coverage/nis/child/infographic-%092013.html


http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a5.htm?s_cid=mm6406a5_w

National, State, and Local Area Vaccination Coverage Among Children Aged 19-35 Months –

United States, 2011. (2012, September 7). MMWR: Morbidity and Mortality Weekly

Report, 61(35), 689-696. Retrieved from

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6135a1.htm?s_cid=mm6135a1_e

%0d%0a

Notifiable Diseases and Mortality Tables. (2015, March 13). MMWR: Morbidity and Mortality

Weekly Report, 64(09); 146. Retrieved from http://www.cdc.gov/mmwr/pdf/wk/mm

6409md.pdf

Taylor, B. (2006, August 9). Vaccines and the changing epidemiology of autism. Child: Care,

Health and Development. 32(5), 511, DOI: 10.1111/j.1365-2214.2006.00655.x

World Health Organization. (2015). Measles. Retrieved from http://www.who.int/mediacentre

/factsheets/fs286/en/

http://www.who.int/mediacentre%20%09/factsheets/fs286/en/

http://www.who.int/mediacentre%20%09/factsheets/fs286/en/

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Appendix

Pay close attention to the graph below that shows the number of measles cases from 2001

to 2013 and then the skyrocket of measles cases in 2014. This is a huge incline and is

concerning to all (Childhood Immunization Coverage, 2013).


Notifiable Mortality / Morbidity Weekly Report - Ending March 7, 2015

Measles Total cases reported for previous years

CurrentWeek

5-year weekly average Cum 2015 2014 2013 2012 2011 2010

# of cases 4 4 110 648 187 55 220 63

(Notifiable Diseases, 2015, pg. 146)

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