Saar Kuzi
Alessandra Coutinho Fernandes
William Cope
Richard Tapping
Kashif Ahmad
Reda Sadki
Shubhra Kanti Karmaker Santu
Adam P Rusch
Elizabeth Edwards
Matthew LawFA16 Immunization Module’s Updates
Relative Safety of Vaccines
Given the recent reactions of parents to restrict vaccinations from their children, I feel that this topic should be revisited especially with the rapidly approaching flu season. The rationale for parents involved in the “anti-vaccinating movement” is closely associated with a Lancet article from 1998 indicating a link between the MMR vaccine and Autism (Olpinksi, 2012). Adding “fuel to the fire” is the extensive media coverage and support from high profile figures that suggest that vaccination may cause more harm than good. Despite current research, suggesting the lack of evidence for this link, many parents still do not vaccinate. This movement has led to the recurrence of many diseases, such as pertussis and measles (Olpinski, 2012). I feel that with the fear of vaccination, many parents are limiting their children from immunity from preventable diseases such as Influenza. In a review study by Halsey, et al (2015), the group mentions that influenza vaccines may have had a greater propensity to cause serious adverse reactions such as fever and febrile seizures in those produced 30-40 years ago. The cause for this may have been due to dose-related problems rather than the preparation method. Currently, vaccinations range from split virus to whole- virus mixtures and while the whole virus vaccines appear to be more effective in adults, further research is warranted to identify the full effect on children. Furthermore, in adults these current vaccines have demonstrated less systemic effects with the majority of the effects being limited to localized mild reactions. Although the influenza vaccine may cause limited adverse reactions, this group advocates for the administration of the vaccine indicating the alternative option of not vaccinating may be more detrimental to the child. Additionally, they suggest that some of adverse reactions may be caused due to different genetic dispositions in different groups of people.
Halsey, NA., Talaat,KR., Greenbaum, A., et al. “The Safety of Influenza Vaccines in Children: An Institute for Vaccine Safety White Paper.” Vaccine. (2015). 33;F1-F67.
Olpinski, M. “Anti-vaccination Movement and Parental Refusals of Immunization of Children in USA”. Pediatria Polska (2012). 87; 381-385.
Nereyda, thank you for bringing this topic to our attention again. It is truly unfortunate that one paper and attention from several public figures can misinform many people in our country about the true nature of vaccinations. I think that many parents do not know much about their own health, much less about healthcare as a whole. I can understand where they may feel some fear and apprehension about injecting these foreign substances into their children, and it is our job as future physicians to understand where this stems from. This also reminds me of what happened recently in California with the measles outbreak in Disneyland. People also completely misinterpret the concept of herd immunity.
The CDC does provide some materials about educating parents on vaccinations: http://www.cdc.gov/vaccines/hcp/conversations/conv-materials.html.
@Jared Shelton, I remember seeing that story of the football cheerleader on the news years ago. I had no idea that it turned out to be fraudulent. I remember thinking to myself that I shouldn't get the seasonal influenza vaccine. Its easy to fall into the trap of readily believing what is broadcasted on the media. As physicians its important to remember that many people fall into those traps. While it may be inconvenient to have to re-educate patients about vaccinations, it's critical to the health of our society that we do so.
Good stuff @Nereyda Ochoa. It is unfortunate that one incorrect publication started a whirlwind of misinformation. This misinformation was ultimately retracted and the physician lost his license; however, the damage was already done. The media picked up the story of vaccines causing neurological symptoms during development and this further perpetuated the public's apprehension of the life-saving therapeutic. I recall one well-known football cheerleader faking that she developed dystonia following a routine vaccination, but that was eventually proven fraudulent. All-in-all, it is a shame that something so important in protecting the well-being of children has been labeled as detrimental to their health. As you mentioned, no deaths have resulted from vaccines and the only side effects are the occasional allergic reactions that are typical of any medication. Good stuff!
@Nereyda Ochoa, thank you for sharing such a heavy topic in an open-minded, thought-out way. In this particular situation, like most volatile ones, it's all too easy for both parties to become caught up in their own defenses. Parents are genuinely terrified while also not the most well informed (Science after all is NOT an easy concept to understand and rather unintuitive for most). In conjunction, health professionals are defensive about rationalizing the need to vaccinate to the point of lacking empathy over the stupidity of the parents. In order to move forward, we must find common ground. We need to gain our patient's trust and realize that their defense mechanisms are more powerful than any rational thought we might want to logically coerce onto them. Connecting to our patients on an emotional level and helping them feel like their worries are appreciated is the major step to improving the rocky relationship that frequently exists between modern medicine and our patients.
Great thread which has hit on the key issue of individual rights versus public good. This is especially relevant to vaccination where the danger (of the disease) isn't obvious and herd immunity is the best defense. At the patient level, listening and understanding their concern(s) is considered the best first step.
@Nereyda Ochoa, I wonder what ways would be the most effective to combat these harmful misconceptions. Obviously, addressing the sources of the misconception, like you did in your update, is important. However, I think this is often not enough. I have met people who cling to the idea that the issue of vaccinations is about their individual right to choose their children's medical treatment and that if they think it might be dangerous for whatever reason they shouldn't have to do it. I think it is important that we re-frame the issue. People should realize that the issue of vaccination is bigger than one child and their parents. This is not an issue that just affects the one child getting the vaccine, but the community as a whole.
I agree with you @victoria lu. Negative public perception of vaccines have been growing in recent years and there is no easy solution. Ironically, many western countries, which have access to these vaccines, are the countries whose citizens are refusing to be vaccinated. A paper from the journal Nature Immunology highlighted these problems and potential ways to resolve this issue. Note: the article was published in 2008.
http://www.nature.com/ni/journal/v9/n12/full/ni1208-1317.html
I appreciate that @Nereyda Ochoa highlights some of the key sources that fuel concerns and misinformation about vaccination. All medical interventions, including vaccines, can have adverse effects. To better educate patients regarding vaccination and dispel misconceptions, we as medical professionals need to first try to understand the apprehensions people might have and where they stem from.