What No One Tells You About Protecting The Immunocompromised: Not A Vaccination Issue.

Advocates for vaccines, such as Voices for Vaccines and Colorado Parents for Vaccines, and others, often say that high immunization rates (90%-95%) are needed to create herd immunity.

For anyone unfamiliar with this concept, it refers to the idea that if enough of the population (or “herd”) is vaccinated, it protects immunocompromised individuals who are unable to be vaccinated due to health concerns. This theory has not been scientifically proven.

Numerous studies, including one reported by the Centers for Disease Control and Prevention (CDC) in October 2018, show recently vaccinated individuals shed diseases when vaccinated with live-virus vaccines. In this particular case, it was a measles outbreak among highly vaccinated individuals, who had received 2-3 doses of the MMR (Measles-Mumps-Rubella) vaccine; demonstrating that fully vaccinated individuals still become infected with vaccine-preventable diseases and can easily transmit them to others, including the immunodeficient. 

To better understand this issue, let’s identify who the immunocompromised are, then discuss how the recently vaccinated can hurt this vulnerable population, and finally what can be done to better protect the immunocompromised. 

Who are the immunocompromised?

According to Cancer.gov, individuals who are immunocompromised often suffer from illnesses (such as AIDS, cancer, diabetes, malnutrition and certain genetic disorders) that decrease their body’s ability to fight infections and other diseases. A weakened immune system may also be caused by certain medicines or treatments, such as anticancer drugs, radiation therapy, and stem cell or organ transplant. 

VeryWellHealth.com expands on this definition by explaining that “There are two complementary systems in the immune system, innate immunity, and adaptive immunity. Innate immunity is immunity people are born with. Adaptive immunity is what most people think of when they think of the immune system. This is the part of the immune system that learns to respond to specific antigens — either through exposure to an infection or through vaccination. Most immunodeficiencies affect the adaptive immune system.”

How can the recently vaccinated spread disease and hurt the immunocompromised?

Healthcare professionals and school administrators should know that individuals recently vaccinated with live-virus vaccines such as MMR, Varicella (Chicken Pox), FluMist, Rotavirus, and others can spread disease through a process called “shedding.” This endangers the immunocompromised more so than any non-vaccinated individual who is not carrying the diseases, and it goes against the CDC’s recommendation for the recently vaccinated to stay away from the immunodeficient. In their guide Chemotherapy and You, the U.S. Department of Health and Human Services, in conjunction with the National Cancer Institute, state: “Stay away from people who are sick… You also need to stay away from children who just had a ‘live virus’ vaccine for chickenpox or polio.

A statement on the St. Jude’s Hospital’s website cautions parents not to allow people who’ve recently been vaccinated to visit children receiving treatment, because “some vaccines are made from live viruses, which can pose a threat to the health of St. Jude patients. Visitors should not enter the hospital: If they have received oral polio or smallpox vaccine within 4 weeks; or if they have rashes after receiving the chickenpox (varicella) vaccine.”

How can we help protect the immunocompromised?

Vaccine advocates claim they are concerned about the immunodeficient, but as demonstrated above they are likely spreading the very diseases they claim they are preventing and thus putting the immunocompromised at a greater risk.  What they often fail to understand is that a simple trip to a grocery store can land an immunocompromised individual in the hospital, not because of so-called vaccine-preventable diseases but rather poor hygiene and/or quarantine habits when one has a cold or other so-called minor illness.

How many times have you observed a sick child sleeping in a shopping cart full of groceries, or an adult clutching a handkerchief to their red and running nose as they grab products from the shelf? What about the contagious people standing in line at the pharmacy to get their antibiotics or other meds, sneezing into their hand and touching the waiting chairs or the keypad or screen on the checkout consoles? Now imagine the next person to use that same shopping cart, or reach for a product on the shelf, or touch the same keypad is undergoing a series of chemotherapy. Their immune system is generally not strong enough to fight even these common illnesses and may end up needing to spend a few nights at the hospital or worse. 

One of the best ways to prevent disease is by washing hands with soap and water and the CDC suggests doing so:

  • Before, during, and after preparing food
  • Before eating food
  • Before and after caring for someone who is sick
  • Before and after treating a cut or wound
  • After using the toilet
  • After changing diapers or cleaning up a child who has used the toilet
  • After blowing your nose, coughing, or sneezing
  • After touching an animal, animal feed, or animal waste
  • After handling pet food or pet treats
  • After touching garbage

Another excellent way to help protect the immunocompromised is to simply stay home or keep your children home during illnesses.  Unfortunately, many parents continue to take their children to daycares, schools, parks, and play places during illnesses, claiming it was “food poisoning” or “seasonal allergies.” On the flip side, some schools tend to chastise or even penalize parents when their children miss too much school, and sadly in some cases will even call CPS on these parents. Regrettably, the workplace is no different when it comes to employees showing up to work while ill, as demonstrated in a 2014-2015 study, where researchers found more than 40% of healthcare workers reported to work while sick.

Let’s stop claiming non-vaccinated individuals are causing any more danger to the immunodeficient than the vaccinated and instead let’s unite on teaching better hygiene and quarantine habits during illnesses. 

References:

1.    Morbidity and Mortality Weekly Report (MMWR). (2018, October 25). Retrieved February 12, 2019, from https://www.cdc.gov/mmwr/volumes/67/wr/mm6742a4.htm  

2.    NCI Dictionary of Cancer Terms. (n.d.). Retrieved January 16, 2020, from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/immunocompromised  

3.    Boskey, E., & Olender, S. (n.d.). How Different Diseases Can Make Your Body Immunocompromised. Retrieved January 16, 2020, from https://www.verywellhealth.com/what-it-means-to-be-immunocompromised-have-immune-deficiency-3132870  

4.    Rosen, B., J., S., J., Hickman, J., C., Sowers, . . . M., C. (2014, February 27). Outbreak of Measles Among Persons With Prior Evidence of Immunity, New York City, 2011. Retrieved January 16, 2020, from https://academic.oup.com/cid/article/58/9/1205/2895266  

5.    Rota, P. A., Khan, A. S., Durigon, E., Yuran, T., Villamarzo, Y. S., & Bellini, W. J. (1995, September). Detection of measles virus RNA in urine specimens from vaccine recipients. Retrieved January 16, 2020, from http://www.ncbi.nlm.nih.gov/pubmed/7494055 

6.    C., J., Treanor, John, E., P., Wolff, Mark, . . . B., R. (2000, February 01). Comparison of the Safety, Vaccine Virus Shedding, and Immunogenicity of Influenza Virus Vaccine, Trivalent, Types A and B, Live Cold-Adapted, Administered to Human Immunodeficiency Virus (HIV)-Infected and Non-HIV-Infected Adults. Retrieved January 16, 2020, from https://academic.oup.com/jid/article/181/2/725/825708  

7.    McKenna, M. (2008, October 16). Polio vaccination may continue after wild virus fades. Retrieved January 16, 2020, from http://www.cidrap.umn.edu/news-perspective/2008/10/polio-vaccination-may-continue-after-wild-virus-fades  

8.    Murti, Krajden, M., Petric, Hiebert, J., Hemming, Hefford, . . . Buynder, V. (2013, December 05). Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013. Retrieved January 16, 2020, from https://www.eurosurveillance.org/content/10.2807/1560-7917.ES2013.18.49.20649  

9.    Suess, T., Remschmidt, C., Schink, S. B., Schweiger, B., Heider, A., Milde, J., . . . Buchholz, U. (n.d.). Comparison of Shedding Characteristics of Seasonal Influenza Virus (Sub)Types and Influenza A(H1N1)pdm09; Germany, 2007–2011. Retrieved January 16, 2020, from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0051653 

10.    Chemotherapy and You – hopkinsmedicine.org. (n.d.). Retrieved January 16, 2020, from https://www.hopkinsmedicine.org/kimmel_cancer_center/patient_information/chemotherapy-and-you.pdf page 31

11.    Visiting guidelines. (n.d.). Retrieved January 16, 2020, from https://www.stjude.org/treatment/patient-resources/caregiver-resources/patient-family-education-sheets/prevent-control-infection/visiting-guidelines.html

12.    When & How to Wash Your Hands | Handwashing | CDC. (n.d.). Retrieved January 16, 2020, from https://www.cdc.gov/handwashing/when-how-handwashing.html  

13.    Chiu, S, et al. “Working with Influenza-like Illness: Presenteeism among US Health Care Personnel during the 2014-2015 Influenza Season.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, 1 Nov. 2017, Retrieved January 16, 2020, from www.ncbi.nlm.nih.gov/pubmed/28526310   

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