Patients much too cavalier about vaccines
Killer Streptococcus pneumonia. It’s not what most of us think about when we think of pneumonia — a cough, a fever, feeling miserable. Yes, Streptococcus pneumonia, also called the pneumococcus, is all of those things too, but very quickly it can grow in your bloodstream and attack the meningeal barrier that protects the brain. In days, it can kill an otherwise healthy person.
Most general internists have seen this killer bacteria in action and are appropriately frightened of it. ER doctors and hospitals are rated by what is called “door to antibiotic time” for pneumonia cases to make sure pneumococcus victims get antibiotics as quickly as possible. But most people who don’t work in health care haven’t heard of this bug. It’s the one your doctor is trying to protect you from when offering either of the two adult pneumonia vaccines.
The vaccines are reported to reduce the risk of dying from the pneumococcus by 70 percent. And yet, a fair number of my patients refuse the vaccine. I can’t say that I’m terribly surprised when this happens — vaccine refusal has become cool. Like bra-burning in the 1960s or teens wearing their pants too low today, it’s a way of defying authority that feels safe. But it isn’t. The U.S. Centers for Disease Control and Prevention attributes about 22,000 deaths a year in the U.S. to the pneumococcus.
In contrast, the CDC reported 96 deaths from shingles last year. And yet, many of the very same patients who decline a pneumonia shot ask me for a shingles vaccine. Though I am in favor of the shingles vaccine and happily give them a prescription for it, I can’t help but ask, why?
“Why do you refuse the pneumonia shot, which can prevent death, but request the shingles shot which prevents a horrible and painful rash but is unlikely to kill you?”
Invariably, the answer is that they know someone or know of someone who has suffered from shingles. They have heard of the pain and disability a shingles attack caused, and who wouldn’t want to prevent that? Streptococcus pneumonia doesn’t easily roll off the tongue and people who die from it, by definition don’t live to tell the tale, unlike the victims of shingles.
Also, it might be hard to decide if you are at self to think about.
This selfishness principle was best and cruelly described on CNN by the anti-vaccine cardiologist, Dr. Jack Wolfson who said, “It’s not my responsibility to inject my child with chemicals in order for (an immunocompromised child) to be supposedly healthy.”
If we don’t have diseases that impair our immune systems like AIDS or cancer, we generally feel safe from infectious diseases. But it is a false sense of security. The only reason that we have been given the benefit of feeling so secure is through constant vigilance of our public health officials and pediatricians. We have been warned for years that if we let our guard down, diseases that we once thought eliminated will come roaring back. And, as we have seen most recently with measles, this has become a very real possibility.
In impoverished areas all over the world, parents walk miles with their children to get the vaccines we take for granted in this country. They know what a death from pertussis or measles looks like. Most of us have blissfully forgotten.
A few months ago, I offered a patient a pneumonia shot. She politely declined.
“OK. Well, would you like a vaccine for Ebola?” I asked her seriously since Ebola had been in the news daily and people were panic-stricken.
“Sure,” she said, “But you don’t really have that do you?”
No, I admitted, I didn’t. Instead I told her that while Ebola had only killed one person in the U.S., pneumonia had killed thousands. She nodded and smiled and still refused.