Childhood Vaccines; Understanding the Science, History and Why They Matter

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Episode 20 Transcript

Childhood Vaccines; Understanding the Science, History and Why They Matter

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Welcome to today’s podcast. My name is Abbie Cornett, and I am the patient advocate for IG Living magazine. This podcast is brought to you by IG Living to give readers the chance to hear directly from healthcare experts on topics that matter to them most.

Abbie: Thank you for joining us today. Today, we’re here to hear about vaccines in the news. Whether discussion about childhood immunization, outbreaks of preventable diseases or heated conversations online, there is no shortage of information, and unfortunately, there’s no shortage of confusion either. For many parents and caregivers, it can feel overwhelming to sort through headlines, social media posts and conflicting opinions — especially when you’re just trying to make the best decision for your child’s health or your own. Today, we’re stepping back from the noise to focus on the facts, history and science.

Today, I’m joined by Dr. Brett Kettlehut who is board certified in pediatrics, as well as allergy and immunology. Dr. Kettlehut is retired from private practice, but continues to be actively involved in education and advocacy. He previously practiced allergy and immunology at Boys Town in Nebraska, served as an adjunct clinical professor in the College of Medicine at the University of Nebraska Medical Center, and currently serves as the president of Nebraska Academy of Allergy, Asthma and Immunology. Dr. Kettlehut brings decades of experience caring for children and families, and today we’ll be talking about childhood vaccines — the different types we hear about in the news, how they work and why they remain such an important part of public health.

Dr. Kettlehut, thank you so much for joining us. Before we get into the different types of vaccines, I’d like to start with the bigger picture. You once told me something that really stayed with me. The two biggest advances in medicine in the 20th century were sanitation and vaccines. Can you explain what you meant by that? And, how vaccines came to play such a critical role in public health, especially for our children?

Dr. Kettlehut: Well, let's first talk about the role of sanitation. It's been known for over 4,000 years that sewage is a source of infection. In fact, they started to address this, especially during the Roman times by creating aqueducts to have fresh water and to remove sewage from the population.

Unfortunately, in the Middle Ages, this concept went away. And they thought of disease being more magical, something in the air that they were catching. And we started seeing increasing outbreaks of cholera and typhoid. In the mid-1800s, there was a cholera epidemic in London, which was found to be due to public drinking water. That was the first public health sort of investigation. And once they determined this was the source of the cholera, and they stopped this public water source, the cholera epidemic went away.

Now we talk about what is the role of vaccination in children. We know that now there still are 500,000 deaths worldwide from children under the age of 5 that have preventable disease but are not vaccinated. And we know with sanitation that approximately 80 percent of bacterial and 20 to 60 percent of viral illnesses can be prevented. So that’s sort of a very rough historical, you know, of sanitation and vaccination.

Abbie: I was going to say when I was at USC taking my epidemiology classes, we studied the cholera outbreak and it being traced to one water pump in London, and it was pretty fascinating. That idea really reframes vaccines as a foundation of modern medicine, not just as a medical intervention. It leads perfectly into questions many parents may have today. The next question is, you know, we are hearing a lot in different terms in the news about vaccines, such as in most recent times and since the pandemic, terms such as mRNA vaccines and more traditional vaccines. Can you explain the main types of vaccines and how they differ and what parents should understand about each of the types of vaccines and how they work?

Dr. Kettlehut: Well, all vaccines work very similar. What they’re doing is they’re introducing an antigen or part of the virus or the bacteria that allows the immune system to recognize that. We’ll talk more about that a little bit later. But the types of current vaccines, the first group is live attenuated vaccines. Commonly, ones would be MMR (measles, mumps and rubella), as well as chickenpox. Then we have the killed viral vaccines, such as polio and some flu vaccines.

Then we have the toxoid vaccines for like diphtheria and tetanus. And the response to that is not to the bacteria but to the toxin that’s released during the bacterial infection. And most recently, we have the subunit conjugated vaccines such as Prevnar. And what that does is it takes critical parts of the bacteria, which is the pneumococcus, and it exposes the immune system to those critical parts.

It’s sort of like an address to a home. The pneumococcus looks the same except for these antigens. And once the body’s been exposed and the immune system has been primed, then in the future, any exposure to that particular serotype of pneumococcus will be thwarted. Just like looking at a house and you see the address. I know this is where I’m supposed to be. All the houses look the same, but I can find out where I am because I have the address.

Abbie: That's a really good way of looking at it. I hadn’t heard that before.

Dr. Kettlehut: I’ve used that a lot to help patients understand what that is. Now finally, we have the most recent, which is the mRNA vaccines, specifically for COVID. And what that does is introduce a small amount of RNA, which is specific to the spike protein of COVID. Because what the mRNA does is actually has your own body make the spike protein for a time, the immune system can see the spike protein and then mount an immune response to keep the infection from getting too severe. It won’t prevent the infection, but it tends to be useful in preventing the severe outcomes of COVID-19.

Abbie: Understanding how vaccines are designed helps make sense why they’ve been so effective over time, and leads to my next question. At a basic level, how do vaccines work with the immune system to protect children from serious illness? Because you’ve explained how the vaccines are made and what they do, but how does it interact with the immune system in the child? How does that work?

Dr. Kettlehut: Well, it's kind of complicated, but I'll try to keep it as simple as possible. Once you receive a vaccine, there are two major portions of your immune system which are activated: the B cell component, which makes immunoglobulins, and the T cell component, which is responsible for cellular immunity. And they have two different roles. And so, it’s by this sort of introduction of the antigens that the immune system will look at this and begin an immune response. The one thing you need to understand about the immune response is it’s not immediate. I’ve told patients that are getting, let’s say, a flu vaccine. I can give you a flu vaccine today and you can get the flu tomorrow. It takes time for those vaccines to become effective because the immune system, if you’ve never seen it, has to kind of learn how to respond. Sort of like if you wanted to take a test for algebra but you never opened the book, you’re not going to do very well.

So, it’s a learning process that the body has to go through for both the antibody and the cellular response to these vaccines.

Abbie: Once parents understand how vaccines work, the next concern has to do frequently with the safety, especially when it comes to the child’s developing immune system. We hear a lot that parents have vaccine hesitancy. Can you explain a little bit how that works with a child’s developing immune system?

Dr. Kettlehut: These vaccines have been shown, historically, to be very safe. It’s reported that a young child could get up to 10,000 individual vaccines at one sitting and still not have any adverse events. The most likely adverse event is our local reactions to the vaccine within about 12 to 24 hours. That generally dissipates within a couple of days.

Abbie: That’s the way they get the little red bulb for the warm area with the vaccine. I’ve seen that before.

Dr. Kettlehut: Absolutely. And that occurs in adults, too. There are rare cases where vaccines can cause adverse events. Those are very infrequent, but those still need to be discussed with parents so they can feel comfortable and know what to look for. But as I mentioned, they’re extremely rare, and we know historically that these vaccines do not cause serious side effects.

Now, the only vaccine, to my understanding, that was ever looked at in-depth with a study was the oral polio vaccine. And that was shown not to have any significant side effects. The problem with current vaccines is these trials have not been completed because it’s just not possible to do these trials, especially when we had COVID. There was just not enough time. It was too urgent to get people vaccinated for COVID to give any sort of real length of time of vaccine. The idea of the association of autism to the MMR vaccine has never been proven. In fact, it’s been disproven multiple times. Unfortunately, it’s gotten in the Internet world that that is a cause of autism.

Now, looking back at my own history, as a child I had all of these viruses. I had measles, mumps. You know, I never had polio, but I do remember getting the polio vaccine. But more importantly, I never saw any autism. And so, why would autism all of a sudden begin now if it was due to the MMR vaccine? It doesn’t make sense to me. So, I really don’t think there’s any credence in tying the MMR vaccine with autism.

Abbie: I was going to say, I had that same conversation with another doctor previously. Everyone in the room was from our generation, and everyone was, we all had the vaccines, and autism was not as prevalent by any means as it is today. That leads to the next question: safety and the immune system. One comment we hear from parents is, and you already answered part of this particularly with the analogy of, or not analogy, but the study that showed a baby could receive 10,000 vaccines. One common concern is that the vaccines place too much stress on a child’s immune system. From your perspective, how does the immune system actually respond to the vaccine? And I know you kind of answered that, but let’s just go over it a little bit further.

Dr. Kettlehut: Quite frankly, you do want the vaccination cause some, as you call it, stress. It’s not bad stress. It’s the stress that you get, the response that you need to produce the antibodies and the cellular response that you want.

Abbie: Some stress is good.

Dr. Kettlehut: So, the concept of stress in the immune system is not one to be concerned about. As I mentioned, we have developed our immune system to be able to response to multiple, not just vaccines, but daily exposures to various antigens. And it’s designed to do that. So, you can’t truly stress the child’s immune system with these vaccinations.

Abbie: Even with that understanding, how do you help alleviate fears of parents when you’re speaking with them about misinformation that they’ve heard? Because I mean, the real key here is communication.

Dr. Kettlehut: Well, I think the one thing you want to do with parents or any patient is just step back and let them talk. Let them tell you what their concerns are and give them the opportunity to express them. Now, you might not be able to change that, but at least you started a conversation and you can give examples as to why someone’s being recommended to get immunization versus not. One of the things that we don’t know, we talk about measles, which is a major problem. We have not seen measles widespread in the population for decades. So no one really understands measles. No one understands how devastating measles can be. So it’s not really even thought to be a serious illness, although we’re seeing otherwise right now, especially in South Carolina, where they’re having a tremendous outbreak of measles, with a lot of children ending up in the hospital.

Abbie: I was going to say, I don’t remember anybody being hospitalized for measles. It’s like you said — something that I haven’t seen. So I think a lot of times there’s a misconception: because we haven’t seen it that it’s not really bad.

Dr. Kettlehut: Well, most doctors have not seen it. The only reason I know it is because I had it. But as far as me being able to, I’ve never diagnosed measles. Once I was treating kids, it just didn’t exist in that time in my practice. Now it’s different. It’s basically in the community, other communities more than ours here, but still it’s out there when you recognize it.

Abbie: So there’s no shortage of misinformation about vaccines online. When the parents are feeling anxious or unsure, what advice do you give them about finding reliable information? And I know you said you let them talk to you and express their concerns and you try to address those. But if you were going to send them, I mean, give them a place to look for their, so they could do their own research, where can they find reliable information? And, how do they have a productive conversation with their child’s healthcare provider?

Dr. Kettlehut: Well, again, you begin the conversation by allowing the parent to discuss their concerns, their fears, and put that into perspective as to reality. Are these true concerns? And then once you’re able to address that, and then if you say, well, where can I go to get an updated, recommended vaccine schedule? And the only place I’ve seen is the American Academy of Pediatrics. If you were to go and Google American Academy of Pediatrics vaccine schedule, they’ll give you all the information as to what is currently recommended. Now that’s not necessarily what they recommended through the CDC because of the politics, but I would trust that because that one is time-proven. The other one is more opinionated. They get these vaccine committees together and it’s their opinion without any sort of real scientific information for backing these opinions.

Abbie: It’s very concerning when you put it that way. So what you’d recommend to a parent, you’d say: Go to the American Academy of Pediatrics to look at the vaccine schedule. That would be your recommendation.

Dr. Kettlehut: Yeah, I have to say something, and it’s a little overwhelming. You know, I mean, there are so many vaccines given to kids now. So my thought would be: Review it, take it, look at it, and then go to your pediatrician or your primary care provider and discuss it and discuss why these are important.

The most recent one that they’ve decided you don’t need is the hepatitis B at birth. But the problem is once a child gets hepatitis B, they’ve got it for life. But by giving it as soon as they’re born, it really prevents that spread of hepatitis B in the newborn. And a lot of times these infections are not even recognized by the mother or the obstetrician that’s delivering the baby. So that’s another vaccination that recently said, well, we don’t need it because we’re not seeing it. Well, we’re not seeing it because we’ve been giving these vaccines. We’ve been giving these for years.

Abbie: Yes, it’s kind of the chicken and the egg.

Dr. Kettlehut: Well, it’s even worse than that. There’s no chicken; there’s no eggs.

Abbie: That’s very true. You know, these concerns become even more important when we think beyond one child. And, when parents go into the pediatrician, they’re talking about their child, their concerns with their child. But can you put it in perspective of the broader community? And that leads me kind of into my next question. Inside the broader community, can you explain a little bit about herd immunity and the families that are affected by it? Especially children who have chronic illness or the parents who have chronic illness or an immune deficiency, how these childhood vaccines play a role in protecting both the individual child and the broader community.

Dr. Kettlehut: When we talk about herd immunity, one way to think of it is wildfires, where if you have a fire in one location, but you’re able to contain it; whatever method you want to contain it, it doesn’t spread. That’s what herd immunity does. The greater the number of individuals who have been immunized, the less likely that they’re going to catch the illness, the viral illness in this case, and spread it. So if you only have a few people that have not been immunized, it’s very unlikely that there’s going be widespread dissemination of this virus. On the other hand, such as in South Carolina, it’s completely different. In fact, when they look at the hospitalization rate, 90 percent or more of these children that are hospitalized have not been vaccinated.

So herd immunity is extremely important for the general population. It’s also very important to protect those individuals who either have certain comorbid conditions that put them at a higher risk of a severe outcome or patients with immune deficiency because they cannot amount an immune response. Not only that, patients with immune deficiency do not get MMR vaccine because it’s a live viral vaccine. It’s contraindicated. So they don’t have, other than what they’re getting (IgG), which has some antibody there, they’re pretty much unprotected.

Abbie: So that’s really kind of frightening when you think about it. And you think about people, and particularly the elderly people whose immunity is lower and your children that can’t take the vaccines, what damage can be done to the community in total.

That brings us to the next question. The idea of community protection helps explain why vaccine rates matter on a much larger scale. But we’re starting to see, and you just talked about the resurgence of measles. What does that tell us as a society? About the importance of childhood vaccination rates?

Dr. Kettlehut: Well, I want to use the example: Let’s not throw the baby out with the bathwater. And that’s what we’ve done with a lot of vaccines. We’ve made an assumption that the vaccines are either not necessary or harmful, and we’re not going to give them. And I think that’s part of the issues that we’re dealing with is this widespread thought that these vaccines are not necessary, but are actually causing some harm. And I think that’s why people become reluctant to have their children vaccinated.

Abbie: And I think part of that reluctance is what you talked about earlier: No one has seen these diseases in so long that they don’t feel that they’re a credible threat any longer. You’ve practiced for a number of years, and I was actually surprised that you said you’d never seen a case of measles. But if you think about it, measles was considered eradicated the United States, correct, for a number of years?

Dr. Kettlehut: Yeah, by the time I went into medical school, I mean, my gosh, I was born in 52, now you know my age. So by the time I went to medical school, measles was no longer, it had been eradicated in the United States. And the other thing that we have to be concerned about is polio. Polio is essentially eradicated, the common polio. There are still wild strains of polio in various countries around the world like India and Pakistan. So if we were to stop doing polio vaccinations, you might see this happen too. And I’ll guarantee you, as a parent back in those years in the mid-50s, that scared the living daylights out of parents to have the potential of their child having polio. So we were very lucky to have these polio vaccines, Sabin and Salk vaccines, when we did.

Abbie: As we wrap up, what is the one message you hope parents and caregivers remember when thinking about childhood vaccines?

Dr. Kettlehut: Well, there's more than one, but the number one thing I would say is that time has shown that these vaccines are safe. And, two, they’re effective in preventing childhood communicable disease. So I would say those are the two major things I want parents to think about. And then to be willing to sit down and have an open discussion with your child’s pediatrician or primary care provider about the safety and efficacy, as well as any potential side effects that may have occurred with vaccinating your child.

Abbie: Dr. Kettlehut, thank you so much for sharing your time, experience and perspective with us today. Conversations like this are so important in helping families move past fear and confusion and toward making more confident decisions in regard to their healthcare and their children’s healthcare.

Abbie: Thank you again for joining us today. Additional information regarding this podcast can be found on our website at www.igliving.com. If you have a question that was not answered, please contact me at acornet@igliving.com.

Look for the next IG Living podcast announcement on our website for the opportunity to submit your questions.

IG Living Advocate is a copywrite production of IG Living magazine, published by FFF Enterprises, the only magazine for the immune globulin community comprised of patients who suffer from chronic illness and their caregivers.

Disclaimer: The views and opinions expressed by the guest speaker are their own and do not necessarily reflect the views of IG Living magazine, FFF Enterprises, or its affiliates. (The language I came up with. Feel free to change it)