Immunization myths and realities: Responding to arguments against immunization
CR MacIntyre,
J Leask,
CR MacIntyre
National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead, Westmead and
University of Sydney, Sydney, New South Wales, Australia
Search for more papers by this authorJ Leask
National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead, Westmead and
University of Sydney, Sydney, New South Wales, Australia
Search for more papers by this authorCR MacIntyre,
J Leask,
CR MacIntyre
National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead, Westmead and
University of Sydney, Sydney, New South Wales, Australia
Search for more papers by this authorJ Leask
National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead, Westmead and
University of Sydney, Sydney, New South Wales, Australia
Search for more papers by this authorFirst published: 16 September 2003
Citations: 22
CR MacIntyre, National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead, Westmead, NSW 2145, Australia. Fax: +61 2 9845 3082; email: [email protected]
†Expert bodies around the world have set different guidelines for safe levels of mercury consumption. The US Environmental Protection Authority has set the lowest cut-off point at 0.7 µg of mercury per kilogram of bodyweight per week, while the WHO has stipulated a higher level, 3.3 µg/kg of bodyweight per week. Australia follows the WHO recommendations, as these levels are still considered to be as much as 10-fold below the levels which pose any health risk.
Abstract
Abstract: As vaccination programs continue to successfully control more and more infectious diseases, and the effects of these diseases become less visible, there has been increased focus on adverse events following immunization. Vaccines have been falsely implicated in the causation of a range of conditions, especially those which affect infants and young children, and whose aetiology is unknown, poorly understood or multifactorial. This paper explores some of the common immunization myths that clinicians may face. It is essential that health professionals have access to accurate information and are able to respond appropriately to parental concerns. This involves good communication; listening, empathy and tailoring advice to the specific concerns of the parent. Finally, health professionals need to provide consistent messages based on solid research evidence.
References
- 1 Dales L, Hammer SJ, Smith NJ. Time trends in autism and in MMR immunization coverage in California. JAMA 2001; 285: 1183−5.
- 2 Kaye JA, Del Mar Melero-Montes M, Jick H. Mumps, measles and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis. BMJ 2001; 322: 460−3.
- 3 Fombonne E. The epidemiology of autism: a review. Psychol. Med. 1999; 29: 769−86.
- 4 Wakefield AJ, Pittilo RM, Sim R et al. Evidence of persistent measles virus infection in Crohn's disease. J. Med. Virol. 1993; 39: 345−53.
- 5 Wakefield AJ, Murch SH, Anthony A et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children [see comments]. Lancet 1998; 351: 637−41.
- 6 Taylor B, Miller E, Farrington CP et al. Autism and measles, mumps and rubella vaccine: no epidemiological evidence for a causal association [see comments]. Lancet 1999; 353: 2026−9.
- 7 Fombonne E, Du Mazaubrun C, Cans C, Grandjean H. Autism and associated medical disorders in a French epidemiological survey. J. Am. Acad. Child Adolesc. Psychiatry 1997; 36: 1561−9.
- 8 Patja A, Davidkin I, Kurki T, Kallio MJ, Valle M, Peltola H. Serious adverse events after measles-mumps-rubella vaccination during a fourteen-year prospective follow-up. Pediatr. Infect. Dis. J. 2000; 19: 1127−34.
- 9 Taylor B, Miller E, Lingam R, Andrews N, Simmons A, Stowe J. Measles, mumps and rubella vaccination and bowel problems or developmental regression in children with autism: population study. BMJ 2002; 324: 393−6.
- 10 Uhlmann V, Martin CM, Sheils O et al. Potential viral pathogenic mechanism for new variant inflammatory bowel disease. Mol. Pathol. 2002; 55: 0−6.
- 11 Stajich GV, Lopez GP, Harry SW, Sexson WR. Iatrogenic exposure to mercury after hepatitis B vaccination in preterm infants [see comments]. J. Pediatrics 2000; 136: 679−81.
- 12 Pichichero ME, Cernichiari E, Lopreiato J, Treanor J. Mercury concentrations and metabolism in infants receiving vaccines containing thiomersal: a descriptive study. Lancet 2002; 360: 1737−41.
- 13 DeStefano F, Vaccine Safety Datalink Research. The Vaccine Safety Datalink project. Pharmacoepidemiol. Drug Safety 2001; 10: 403−6.
- 14 Institute of Medicine. Immunization Safety Review: Thimerosal-Containing Vaccines and Neurodevelopmental Disorders. In: Stratton K, Gable A, McCormick MC, eds. National Academy Press, Washington DC, 2001.
- 15 Farooqi IS, Hopkin JM. Early childhood infection and atopic disorder. Thorax 1998; 53: 927−32.
- 16 Hurwitz EL, Morgenstern H. Effects of diphtheria-tetanus-pertussis or tetanus vaccination on allergies and allergy-related respiratory symptoms among children and adolescents in the United States. J. Manipulative Physiol. Ther. 2000; 23: 81−90.
- 17 Kemp T, Pearce N, Fitzharris P et al. Is infant immunization a risk factor for childhood asthma or allergy? Epidemiology 1997; 8: 678−80.
- 18 Kramarz P, Destefano F, Gargiullo PM et al. Does influenza vaccination prevent asthma exacerbations in children? [Comment]. J. Pediatrics 2001; 138: 306−10.
- 19 Kramarz P, DeStefano F, Gargiullo PM et al. Does influenza vaccination exacerbate asthma? Analysis of a large cohort of children with asthma. Vaccine Safety Datalink Team. Arch. Family Med. 2000; 9: 617−23.
- 20 Barlan IB, Tukenmez F, Bahceciler NN, Basaran MM. The impact of in vivo Calmette-Guérin bacillus administration on in vitro IgE secretion in atopic children. J. Asthma 2002; 39: 239−46.
- 21 Choi IS, Koh YI. Therapeutic effects of BCG vaccination in adult asthmatic patients: a randomized, controlled trial. Ann. Allergy, Asthma Immunol. 2002; 88: 584−91.
- 22 Wickens K, Crane J, Kemp T et al. A case-control study of risk factors for asthma in New Zealand children. Aust. NZ J. Public Health 2001; 25: 44−9.
- 23 Anderson HR, Poloniecki JD, Strachan DP et al. Immunization and symptoms of atopic disease in children: results from the International Study of Asthma and Allergies in Childhood. Am. J. Public Health 2001; 91: 1126−9.
- 24 Strachan DP. Family size, infection and atopy: the first decade of the ‘hygiene hypothesis’. Thorax 2000; 55: S2−10.
- 25 Robinson DS, Hamid Q, Ying S et al. Predominant TH2-like bronchoalveolar T-lymphocyte population in atopic asthma. N. Engl. J. Med. 1992; 326: 298−304.
- 26 Ryan EJ, Nilsson L, Kjellman N, Gothefors L, Mills KH. Booster immunization of children with an acellular pertussis vaccine enhances Th2 cytokine production and serum IgE responses against pertussis toxin but not against common allergens. Clin. Exp. Immunol. 2000; 121: 193−200.
- 27 Nilsson L, Kjellman NI, Bjorksten B. A randomized controlled trial of the effect of pertussis vaccines on atopic disease. Arch. Pediatr. Adolesc. Med. 1998; 152: 734−8.
- 28 DeStefano F, Gu D, Kramarz P et al. Childhood vaccinations and risk of asthma. Pediatr. Infect. Dis. J. 2002; 21: 498−504.
- 29 Anon. The safety of inactivated influenza vaccine in adults and children with asthma. N. Engl. J. Med. 2001; 345: 1529−36.
- 30 Institute of Medicine. Immunization Safety Review: Multiple Immunizations and Immune Dysfunction. In: Stratton K, Wilson CB, McCormick MC, eds. National Academy Press, Washington DC, 2002; 1.
- 31 Byard RW, Mackenzie J, Beal SM. Vaccination and SIDS: information from the South Australian SIDS Database. Med. J. Australia 1995; 163: 443−4.
- 32 Jonville-Bera AP, Autret E, Laugier J. Sudden infant death syndrome and diphtheria-tetanus-pertussis-poliomyelitis vaccination status. Fundamental Clin. Pharmacol. 1995; 9: 263−70.
- 33 Mitchell EA, Stewart AW, Clements M. Immunisation and the sudden infant death syndrome. NZ Cot Death Study Group. Arch. Dis. Childhood 1995; 73: 498−501.
- 34 Essery SD, Raza MW, Zorgani A et al. The protective effect of immunisation against diphtheria, pertussis and tetanus (DPT) in relation to sudden infant death syndrome. FEMS Immunol. Med. Microbiol. 1999; 25: 183−92.
- 35 Fleming PJ, Blair PS, Platt MW, Tripp J, Smith IJ, Golding J. The UK accelerated immunisation programme and sudden unexpected death in infancy: case-control study. BMJ 2001; 322: 822.
- 36 Nagler J. Sudden infant death syndrome. Curr. Opin. Pediatr. 2002; 14: 247−50.
- 37 Krous HF, Nadeau JM, Silva PD, Byard RW. Infanticide: is its incidence among postneonatal infant deaths increasing?: an 18-year population-based analysis in California. Am. J. Forensic Med. Pathol. 2002; 23: 127−31.
- 38 Sanderson CA, Cowden B, Hall DM, Taylor EM, Carpenter RG, Cox JL. Is postnatal depression a risk factor for sudden infant death? Br. J. Gen. Prac 2002; 52: 636−40.
- 39 Monteyne P, Andre FE. Is there a causal link between hepatitis B vaccination and multiple sclerosis? Vaccine 2000; 18: 1994− 2001.
- 40 Marshall E. A shadow falls on hepatitis B vaccination effort. Science 1998; 281: 630−1.
- 41 Sadovnick AD, Scheifele DW. School-based hepatitis B vaccination programme and adolescent multiple sclerosis. Lancet 2000; 355: 549−50.
- 42 Touze E, Fourrier A, Rue-Fenouche C et al. Hepatitis B vaccination and first central nervous system demyelinating event: a case-control study. Neuroepidemiology 2002; 21: 180−6.
- 43 Ascherio A, Zhang SM, Hernan MA et al. Hepatitis B vaccination and the risk of multiple sclerosis. N. Engl. J. Med. 2001; 344: 327−32.
- 44 Confavreux C, Suissa S, Saddier P, Bourdes V, Vukusic S, Vaccines in Multiple Sclerosis Study Group. Vaccinations and the risk of relapse in multiple sclerosis. N. Engl. J. Med. 2001; 344: 319−26.
- 45 Chen RT, Hibbs B. Vaccine safety: current and future challenges. Pediatr. Ann. 1998; 27: 445−55.
- 46 Kubler-Ross E. On death and dying. Bull. Am. College Surgeons 1975; 60: 15−7.
- 47 Wilkinson L. Sir Austin Bradford Hill: medical statistics and the quantitative approach to prevention of disease. Addiction 1997; 92: 657−66.
- 48 Streefland PH. Public doubts about vaccination safety and resistance against vaccination. Health Policy 2001; 55: 159−72.
- 49 Leask J. Vaccination and risk communication: summary of a workshop, Arlington Virginia, USA, 5−6 October 2000. J. Paediatr. Child Health 2002; 38: 124−8.
Citing Literature
