WASHINGTON – Marylanders looking to avoid the winter flu or get vaccinated for a trip abroad this year are more likely to develop a reaction than in any year since 1990.
So far this year, 326 “adverse events” from vaccinations have been reported in Maryland, up from 308 reported reactions in 2006, according to Centers for Disease Control and Prevention data. The number of reactions this year is a 307 percent increase from the 80 first reported in 1990.
The highest number of reactions reported in a previous year is 313, both in 1999 and 2003.
It’s hard to know if these changes are significant because health officials could not give an estimate of shots given in Maryland each year.
“There is really no number because they are given by so many different doctors and clinics,” said Greg Reed, Maryland health department immunization director. “The data that we primarily focus on are children around 2 years of age. Ninety-nine percent of children have the vaccines that are required for them to attend school.”
The number of shots given each year fluctuates, Reed said, sometimes due to recommendations from national health agencies like the American Academy of Pediatrics, or vaccines added to the vaccination schedule, as in the case of influenza and hepatitis A recently.
The system used to gather the reaction information is passive, which means nearly anyone can report a reaction, for any reason.
“Manufacturers are required to report,” Allen said. “It’s really an early warning system, not necessarily a casual relationship. If there are a disproportionate number of adverse events we would look into it.”
But the increases in reactions come with an increase in the number of vaccinations, something experts view as a positive.
“There are more vaccines today than there were a few years ago and that’s a good thing because we can prevent more diseases than before,” Allen said.
The bulk of the reactions are not severe, he said.
“Most reactions result in soreness at the arm at the injection site, slight fever, crankiness, that sort of thing,” Allen said.
Only 22 severe reactions occurred in Maryland in 2007, and usually feature encephalitis, a swelling of the brain, and an increased fever resulting in hospitalization, Allen said.
Despite the overall increase in the number of reported reactions, there have been no reported deaths due to vaccinations in Maryland in 2007. Last year saw two Marylanders die from adverse reactions to shots.
Diphtheria, tetanus and pertussis (whooping cough) vaccines and medications account for the most Maryland reactions in 2007, with 71 reported, according to CDC data.
The combined vaccine is one of nine that Maryland children must have before they can attend a Maryland school.
Other school-age required vaccines protect against polio, measles, mumps, rubella, chickenpox and hepatitis B. Children also must receive both an HIB vaccine, to protect against severe throat swelling, and a dose of Prevnar, a vaccine designed to prevent meningitis and bloodstream infections, for children under five.
Officials from the Maryland health department could not offer any reasons for the reported increase, but did say it is harder for school-age children to get shots, due to the Maryland nursing shortage.
“What you see now is the number of schools that are able to offer immunization at school is reduced,” Reed said. “Previously schools, parents and health facilities would use these school functions to augment their children’s health care. That puts increased pressure on local health departments and private doctors to be able to service these children.”
There is typically a two-year training period for nurses before they can give shots on their own, said Rosemary Mortimer, president of the Maryland Nurses Association.
“We spend four or five hours teaching students in a lab, and then they have to pass a hands-on test and then we observe them in a clinical area,” Mortimer said. “The number of shots they give depends. If they’re in a certain area they’re not going to give a lot of shots. If they’re involved in free clinics and things like that, they can give 50 or so in a day.”
Children from age 6 to 17 were the most likely to react thus far in 2007, with 73 adverse events reported to CDC – the most since 1990 and up from the 39 reactions reported last year.
The increase could be due to changes in vaccination schedules in Maryland, Reed said.
Middle school students are now required to have three doses of hepatitis B vaccine and an age-appropriate dose of the chicken pox vaccine, Reed said.
Immunizing school children has been a flash point in Maryland this year, with schools taking strides to vaccinate their students, with the help of the judicial system.
More than 1,000 children in Baltimore and Prince George’s County were taken out of school because they had not received proper immunizations.
Recently Maryland officials have threatened to impose jail time for parents of children who have not had their required shots.
Maryland law does exempt children from inoculations for religious or medical reasons; other states allow exemptions for philosophical differences, Reed said.
A study done in 1998 raised concerns that the amounts of mercury in vaccines given to young children – specifically in the measles, mumps and rubella shot – could help cause autism.
The concerns centered on the presence of the preservative thimerosal.
“Thimerosal has been removed from all the recommended childhood vaccines with the exception of some influenza vaccinations, but they aren’t required to attend school,” Allen said. “We understand the concerns of parents because we’re parents ourselves, but the science doesn’t suggest a link.”