Not Vaccinating: A Medical Student\'s Perspective?>

Not Vaccinating: A Medical Student's Perspective

by Keng Lam, MD

One day during my family medicine rotation at UC Davis School of Medicine, where I am a third-year student, I saw a pediatric patient whose mother had brought him in for a same-day appointment. Sam was three years old and had a high fever, with temperature up to 104°F, and few to no other symptoms.

As any provider would do, I started to run mentally through the differentials—a fancy way to say coming up with a list of the most likely diagnosis. It wasn't a short list; a high fever in a child can stem from a multitude of causes, ranging from a simple viral upper respiratory illness to bacterial meningitis, a life-threatening bacterial infection.

I went into the patient room and greeted the mom and our young patient. Among my first questions: “Is Sam up to date with his vaccines?” When she responded that he was, I sighed in relief. Had this young patient not been vaccinated, there would be an entirely different list of potential diagnoses for his fever, some of them very dangerous. I spoke with my supervising physician and we decided that Sam’s fever was likely caused by a viral infection. He could be sent home, and his fever managed with over-the-counter medication as needed.

The next day, I gave the mom a follow up call, and I was happy to hear Sam was feeling better. Then I started to think about how the scenario might have played out had Sam not been vaccinated.

Here is what likely would have happened: Sam and his mother would be sent to the emergency room because we might be afraid of missing a serious illness that was preventable by vaccines, such as measles or epiglottitis. The emergency medicine doctors would likely decide to admit him to the hospital and have Sam suffer through a blood draw and possibly other tests like a chest X-ray and lumbar puncture. That would be not only costly (to the family or medical system or both) but scary for the whole family. In the best case scenario, the tests wouldn’t turn up anything worrisome and Sam would be monitored and possibly discharged the next day. But in the worst case scenario, he might actually have been infected by a preventable disease like the ones above, which could send him to the pediatric intensive care unit. And if other people had been in close contact with Sam who also weren’t vaccinated or who had compromised immunity, they may have been infected too. As you can see, a common problem like fever can escalate very quickly.

In the U.S., 91.5 percent of children between 19 months and 3 years old received the vaccine for measles, mumps, and rubella in 2013, according to the CDC—which means that more than 8 percent, or about one in 12 children, did not have those vaccines. And fewer than three-quarters of them received all seven necessary vaccines. It is not surprising that we’ve begun seeing more outbreaks of preventable diseases in the last decade (case in point: measles at Disneyland).

Bottom line:When children are vaccinated, everyone wins. It makes the provider’s job easier by ruling out the scariest diagnoses, protects the parents from undue stress, and most important, protects their little ones from pain and suffering. From a perspective of a provider, it is a no brainer that all children should be fully vaccinated, assuming they have no medical conditions that prevent them from doing so.

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