A A R O N G U N D E R S O N , M DS A N F O R D C H I L D R E N ’ S C L I N I C

VACCINE MYTHS

20th CenturyAnnual Morbidity

2008 PercentDecrease

DiphtheriaMeaslesMumpsPertussisPolio (paralytic)RubellaCongenital Rubella SyndromeTetanusH. influenzae,

type b and unknown (<5 yrs)

175,885503,282152,209147,271

16,31647,745

8231,314

20,000

0140450

13,2780

160

21

140

10099.999.891.010099.910098.5

99.3

Source: CDC

COMPARISON OF 20TH CENTURY ANNUAL MORBIDITY AND CURRENT MORBIDITY, VACCINE-PREVENTABLE

DISEASES

VACCINE CONCERNS

• Under increasing criticism• Concern with safety• Concern with efficacy

• Victim of own success• Diseases are seen infrequently• More focus on side-effects of vaccines themselves

• Popular media’s influence

VACCINE MYTHS ARE NOT NEW

• Edward Jenner• Country doctor in England in late 1700s• Developed “Cowpox” vaccine for smallpox• Vaccine develop 1798• Criticism - 1802

“The Cow Pock – or – the Wonderful Effects of the New Inoculation!”J. Gillray, 1802

Vaccine Concerns: As Old As Vaccines Themselves

It’s no longer enough to say, “Trust us, we’re the experts.”

Physicians and health educators must deal fully and respectfully with the vaccine safety concerns of parents and patients.

6 POINTS WHEN DISCUSSING VACCINE CONCERNS WITH FAMILIES

• Be respectful, solicit questions • Be empathetic if parents have concerns• Educate the parent before the day of the

immunization• Give information tailored to the parents

concerns• Be informed about current vaccine

allegations• Strongly recommend vaccines

VACCINES DON’T WORK

0100200300400500600700800900

1950 1960 1970 1980 1990 2000

Cas

es (t

hous

ands

)

Vaccine Licensed

Measles – United States, 1950-2001

Source CDC

VACCINES AREN’T NECESSARY

DISEASES REAPPEAR WHEN COVERAGE DROPS

VACCINES ARE NOT SAFE

POLIO VACCINE ADVERSE REACTIONS

• Rare local reactions (IPV)• No serious reactions to IPV have been documented• Paralytic poliomyelitis (OPV)

MMR ADVERSE REACTIONS

• Fever 5%-15%• Rash 5%-15%• Joint symptoms 25%• Thrombocytopenia <1/30,000 doses• Parotitis rare• Deafness rare• Encephalopathy <1/1,000,000 doses

• Swelling, redness, and/or pain in 5%-30% of recipients

• Systemic reactions infrequent• Serious adverse reactions rare

Haemophilus influenzae type bAdverse Reactions

DIPHTHERIA AND TETANUS TOXOIDSADVERSE REACTIONS

• Local reactions (erythema, induration)• Exaggerated local reactions reactions (Arthus-type)• Fever and systemic symptoms uncommon• Severe systemic reactions rare

DTAP ADVERSE REACTIONS

• Local reactions• Low grade fever• More severe adverse reactions uncommon• Local reactions more common following 4th and

5th doses

HEPATITIS B ADVERSE REACTIONS

• Pain at injection site• Mild systemic complaints

(fatigue, headache)• Temperature >37.7 C• Severe systemic reactions

Adults13%-29%11%-17%

1%rare

Infants and Children3%-9%

0%-10%

0.4%-6%rare

PNEUMOCOCCAL VACCINES ADVERSE REACTIONS

• Local reactions• polysaccharide 30%-50%• conjugate 10%-20%

• Fever, myalgias• polysaccharide <1%• conjugate 15%-24%

• Severe adverse reactions rare

VACCINES CAUSE AUTISM

AUTISM AND MMR

• The Wakefield Study• First published in 1998 by Andrew Wakefield and Colleagues

• 12 children with development delays, 8 with autism• All had intestinal complaints• Parents associated onset of developmental changes within 1

month of receiving MMR in 8 of the children• Hypothesis was MMR vaccine caused intestinal disease that

resulted in decrease absorption of nutrients and subsequent onset of disease

AUTISM AND MMR

• Flaws in Wakefield Study• Timing of vaccine coincides with when autism is typically

diagnosed. 90% of children in England were vaccinated at the time. More accurate would be to look at vaccinated/unvaccinated populations and determine if was a difference in incidence – this wasn’t done.

• Although the authors claim intestinal inflammation led to the developmental disorders, 5 of the children developed the intestinal symptoms after diagnosis of autism.

• Brian Deer Investigation

• Article retracted – Feb 2, 2010

AUTISM AND MMR

• 1999, Taylor and co-workers published paper looking at 498 children with autism or autistic-like disorders. Looking at incidence and age of onset in vaccinated and unvaccinated children:

• No difference in frequency between vaccinated/unvaccinated

• No difference in the age of diagnosis

• The onset of symptoms of autism did not occur within two, four, or six months of receiving the MMR vaccine

• The known number of ASD cases has been increasing since 1979, but there was no jump after the introduction of MMR vaccine in 1988

AUTISM AND MMR

• Madsen and Colleagues in Denmark• Study involved 537,303 children between 1991 and 1998• 82% immunized• Risk of autism same between immunized and unimmunized

children• No association between the age at the time of

vaccination, the time since vaccination, or the date of vaccination and the development of autism.

Plotkin S et al. Clin Infect Dis. 2009;48:456-461© 2009 by the Infectious Diseases Society of America

STUDIES THAT FAIL TO SUPPORT AN ASSOCIATION BETWEEN MMR VACCINE AND

AUTISM.

A PRESERVATIVE CONTAINED IN MANY VACCINES HARM CHILDREN

THIMEROSOL AND AUTISM

• Thimerosol • Mercury based preservative• Used in some vaccines, primarily in multi-dose vials

• 1999 FDA review showed infants may be getting higher than EPA recommended levels of mercury

• Levels were not higher than FDA or WHO standards

THIMEROSOL AND AUTISM

• Vaccines containing thimerosol in use since 1930’s

• Mercury is cleared from the body in 2 months• No studies have shown an association between

thimerosol and development of autism• During periods of increased mercury exposure

in the past, no associated increase in autism rates

• 2001 - Recommended vaccines be thimerosol free

INFANTS ARE TOO YOUNG TO RECEIVE VACCINES

IT’S BETTER TO BE NATURALLY INFECTED THAN IMMUNIZED

VACCINES WEAKEN THE IMMUNE SYSTEM

VACCINES USE UP THE IMMUNE SYSTEM

HEPATITIS B VACCINE CAUSES SIDS

SIDS AND HEPB

• ABC television news magazine 20/20 ran an episode linking HepB and SIDS• Included a picture of a baby infant who died of SIDs 16

hours after receiving HepB vaccine

SIDS AND HEPB

• When HepB introduced, 5000 children died yearly from SIDs

• 10 years after introduction• 90% of all infants receive HepB• Deaths from SIDs decreased to 1400/year

• So while vaccination rate increased, total deaths decreased

• Statistically given number of vaccinations and SIDs deaths, some would occur with 24 hours of the other

VACCINE-PREVENTABLE DISEASES OCCUR MORE OFTEN IN VACCINATED PEOPLE THAN IN

UNVACCINATED PEOPLE

THE DTP VACCINE CAUSES A DISEASE THAT LOOKS LIKE “SHAKEN BABY”

SYNDROME

THE DTP VACCINE CAUSED DEAFNESS IN THE WINNER OF THE MISS AMERICA

PAGEANT

WHERE TO GO FOR ANSWERS

• Websites• Allied Vaccine Group

http://www.vaccine.org/• CDC's Division of Viral Hepatitis

www.cdc.gov/hepatitis• CDC's National Immunization Program

www.cdc.gov/nip• Childhood Immunization Support Program

http://www.cispimmunize.org/• Immunization Action Coalition

http://www.immunize.org/ & http://www.vaccineinformation.org/• Nat'l Network for Immunization Information (NNii)

http://www.immunizationinfo.org/• Nat'l Vaccine Program Office (NVPO)

www.cdc.gov/od/nvpo• Vaccine Education Center at Children's Hospital of Philadelphia

http://www.vaccine.chop.edu/

WHERE TO GO FOR ANSWERS

• Phone Numbers• CDC's Hepatitis Hotline

Get information by recording, fax, or voice. (888) 443-7232 (4HEPCDC)

• CDC's Immunization Information HotlineA toll-free number for consumers and health professionals who have questions about vaccine-preventable diseases.• English: (800) 232-2522 • Spanish: (800) 232-0233• TTY: (800) 243-7889 (teletypewriter)

BOOKS FOR PARENTS

• Vaccines and Your Child: Separating Fact from Fiction By Paul Offit, MD, and Charlotte Moser, MD. Columbia University Press; 1 edition (February 28, 2011)

• Parents' Guide to Childhood Immunization• A 94-page booklet from CDC's National Immunization

Program at www.cdc.gov/nip/publications/Parents-Guide/default.htm

• Call (800) 232-2522 or complete the online order form at: www.cdc.gov/nip/publications