Controversy misconceptions regarding vaccine safety; however, parental refusal

Controversy surrounding an autism-vaccine
link has elicited considerable news media attention (Dixon & Clarke, 2012).
Fear of disease has shifted to concerns regarding vaccine safety. Scientific
evidence has refuted many of the misconceptions regarding vaccine safety;
however, parental refusal of vaccines is increasing (Chatterjee & O’Keefe,
2010). This paper evaluates the proposed causal relationship between the
measles-mumps-rubella (MMR) vaccines with autism as a potential trigger. Family
physicians and advanced care providers should be knowledgeable about vaccines in
order to inform their patients of the benefits of immunization and any proven
risks. If immunization rates continue to fall, the incidence of
vaccine-preventable illnesses may rise.

PubMed, Embase, and CINHAL were used to
conduct a complete literature review with results yielding preeminent evidence.
Using the key words pediatric, pediatrics, children, vaccine, vaccines,
measles, mumps, rubella, MMR, and autism, a search for the best evidence based
research regarding the misconceptions, benefits of immunization, and scientific
indications surrounding vaccine safety was formulated. Search criteria were
limited to English and reviewed articles published within the last 8 years to
yield the most landmark evidence.

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The book “Do you Believe in Magic? Vitamins,
Supplements, and All Things Natural: A Look Behind the Curtain” by Paul A.
Offit, MD was read in its entirety to evaluate clinician and patient use of
vaccinations and beliefs in their successes. The purpose of this assignment is
to highlight the debate regarding differing perspectives on integrative health
and the influence on the care we as advanced practice nurses provide to
patients. I will specifically discuss the autism-vaccine controversy on vaccine
safety perceptions and behavioral intentions.

On September 24, 2008, Oprah Winfrey
interviewed Jenny McCarthy about her book Mother
Warriors: A Nation of Parents Healing Autism Against All Odds. McCarthy’s
son had been diagnosed with autism and she did not have trust in mainstream
providers because they did not know what caused autism or how to cure it. She,
on the other hand, felt she knew the answer to both. McCarthy spoke strongly on
autism being caused by vaccines stating, “Right before my son got the MMR shot,
I said to the doctor, ‘I have a bad feeling about this shot. This is the autism
shot, isn’t it?’. Preceding the MMR shot, she acknowledged a noticeable change
in her son ultimately faulting the MMR vaccine. Further into the interview,
Oprah validates what McCarthy speaks on by stating, “She wrote the book, she
knows what she is talking about” (Offit,
2013).

Using the
search criteria and keywords stated above, five articles were reviewed for
credibility and reliability. One
article in particular analyzed data from a case control study conducted in 3
managed care organizations (MCOs) of 256 children with autism spectrum disorder
(ASD) and 752 control children matched on birth year, sex, and MCO. ASD
diagnosis were validated through standardized in-person evaluations. Exposure
to antibody-stimulating proteins and polysaccharides from vaccines were
determined by summing the antigen content of each vaccine received, as obtained
from immunization registries and medical records. Potential confounding factors
were ascertained from parents’ interviews and medical charts. Conditional
logistic regression was used to assess associations between ASD outcomes and
exposure to antigens in selected time periods. The results of this study proved
with a confidence interval of 95% that there is no increased risk for ASD with
vaccinations (DeStefano, Price, & Weintraub, 2013).

Another set of investigators studied 1.8
million Finnish children who received almost 3 million doses of MMR vaccine
over 14 years and found no vaccine-associated cases of autism. In California,
retrospective analyses of MMR immunization coverage and children with autism
also did not suggest an association between MMR vaccine and an increased
incidence of autism (Sanford, 2002).

Subsequently,
results of several large population and ecologic-based studies have failed to
provide any support for McCarthy’s theory that vaccinations indeed cause
autism. Further details about this controversy and autism research have been
published by the Institute of Medicine in a report on vaccine safety stating,
“the committee concludes that the evidence favors rejection of a causal
relationship between MMR vaccine and autism” (Chatterjee & O’Keefe, 2010).

Before vaccines, Americans could expect that
every year diseases such as diphtheria, rubella, polio, and mumps would impair
or possibly kill thousands of children. In the developed world, vaccines have
almost completely eliminated these diseases (Offit, 2013). Parent’s today are overwhelmed with
vaccine controversies and decisions they are facing, affecting their children’s
health and well-being. McCarthy’s public denouncement of vaccines along with
internet blogs hosted by anti-vaccine activists influence many parents against
vaccinating their children. When Oprah gave credence to McCarthy’s anti-vaccine
message, it had an effect and it did a lot of harm. Americans have witnessed an
increase in hospitalizations and deaths from diseases like whooping cough,
measles, mumps, and bacterial meningitis because some parents have become more
frightened by vaccines than by the diseases they prevent. Although McCarthy
doesn’t mention it in her books, researchers have shed a great deal of light on
the causes of autism. Given our understanding of the disorder, McCarthy’s
theory to avoid vaccinating children to lessen the risk of autism is not only
useless, it’s dangerous (Offit,
2013).

Parents who choose not to vaccinate
are not lessening their children’s risk of autism; instead they are increasing
their child’s risk of suffering from preventable diseases (Offit, 2013). Therefore, it is imperative that
healthcare providers are prepared to respond to patient and parent anxieties
related to emerging concerns regarding vaccine safety. 

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