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Sure shot

On the importance of a good vaccination plan

Preventive medicine gets a bad rap.

“We typically don’t consider our health until the day we wake up feeling bad,” according to Arturo Gonzalez, president of the Arizona chapter of the American Academy of Pediatrics. “We think about what to do to feel better, instead of focusing on how to prevent sickness in the first place.”

The way to do that, says Gonzalez, a doctor in private practice at Scottsdale Children’s Group, is to vaccinate. “But first,” he insists, “we all have to get over some big misconceptions about vaccines and their benefits.”

Among the many myths about immunization is that it is just for kids – that we all magically arrive at an age where “getting shots” is somehow behind us. But college students, middle-aged adults and senior citizens (especially senior citizens) need immunizations – either boosters or annual shots like the flu vaccine – to stay well.

Seniors are especially vulnerable to serious diseases, and a renewed vaccine schedule can not only help an older person stay well, but will prevent the spread of disease through the wider elderly community in a day-care facility or nursing home.

There is also a real need for pregnant women to be mindful of vaccinations, which will help protect both mom and baby. If you are trying to get pregnant, it is best to avoid live vaccines within a month before conception, although inactivated vaccines can be given at any time before or during pregnancy. A woman who is pregnant during flu season should plan to receive the current, inactivated flu vaccine, because a pregnant woman who gets the flu is at risk for serious complications during pregnancy.

It is perfectly safe for a woman to receive vaccines after giving birth, even while she is breastfeeding. In fact, most pediatric physicians recommend a TDaP vaccination (against tetanus, diphtheria and pertussis) right after delivery. Vaccinating a new mother against pertussis (whooping cough) can reduce the risk to her newborn, too. Finally, a woman who hasn’t had measles, mumps, rubella or varicella (chickenpox) should be vaccinated before leaving the hospital after giving birth.

The immunization rate in Arizona is 76.4 percent. In order for the state to be completely protected from serious disease outbreaks, that percentage must, according to Gonzalez, rise to 92 percent.

 “But that’s going to take some real work,” he insists, “because when you are talking about vaccines, there are so many nay-sayers. People will say, ‘Don’t get a flu shot; the government is pushing you to do it.’ Yet, most vaccines aren’t provided by the government. Or they say, ‘you are overwhelming your immune system,’ but that’s hardly possible.”

Gonzalez likes to challenge those who minimize the importance of vaccines. “I say to them, ‘If you can name one disease on the face of earth that has been eradicated with something other than a vaccine, please do.’ Of course, they can’t.”

Gonzalez is also troubled by the suggestion that doctors are making money from vaccines. “I don’t work for the pharmaceutical companies, and I don’t get kickbacks,” he insists. “In fact, doctors lose money on vaccines, and we always have.”

That’s true, despite the fact that insurance companies will often cover as much as 100 percent of a vaccine’s cost, because the hosting facility must purchase refrigerators in which to store the vaccine, as well as syringes and liability insurance and nurses to administer the drugs.

Still, most physicians are willing to lose money on immunizations, if it means curtailing the state’s ongoing battle with infectious diseases. In February, an Arizona House of Representatives’ Health and Human Services Committee reported that local outbreaks of communicable viruses, once thought to be on the decline, are, in fact, on the rise. A panel of medical experts discussed the importance of childhood immunizations in preventing the occurrence and spread of illness, and acknowledged that people in some ethnic and income groups, who may not have health insurance, often don’t visit doctors with much regularity, and therefore don’t maintain a strict vaccination schedule.

“If you can’t afford to go to a general practitioner, go to the state health department,” says Gonzalez, who was among the House Committee’s panelists. “They provide free immunizations. Vaccines protect more than just our families. They protect the state. One case of measles in a local school district could ultimately cost taxpayers more than $800,000 in attempting to inhibit the disease’s spread. Immunization is no longer just about keeping your kids from getting sick. It’s about protecting all of us.”

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This Article appears on the April 2012 issue of LPM under Health

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