Applied Evidence

When the answer to vaccines is “No”

J Fam Pract. 2018 June;67(6):348-351,359-364

From The Journal of Family Practice | 2018;67(6):348-351,359-364.

References

1. Paterson P, Meurice F, Stanberry LR, et al. Vaccine hesitancy and healthcare providers. Vaccine. 2016;34:6700-6706.

2. Opel DJ, Heritage J, Taylor J, et al. The architecture of provider-parent vaccine discussions at health supervision visits. Pediatrics. 2013;132:1037-1046.

3. Palmer J, Carrico C, Costanzo C. Identifying and overcoming perceived barriers of providers towards vaccination: a literature review. J Vaccines. 2015;1-7.

4. Autism Science Foundation. Making the CASE for vaccines: a new model for talking to patients about vaccines. Available at: http://autismsciencefoundation.org/wp-content/uploads/2015/12/Making-the-CASE-for-Vaccines-Guide_final.pdf. Accessed April 8, 2018.

5. Jacobson RM, Van Etta L, Bahta L. The C.A.S.E approach: guidance for talking to vaccine-hesitant patients. Minn Med. 2013;96:49-50.

6. Henrickson NB, Opel DJ, Grothaus L, et al. Physician communication training and parental vaccine hesitancy: a randomized trial. Pediatrics. 2015;136:70-79.

7. Centers for Disease Control and Prevention. Key facts about seasonal flu vaccine. Available at: https://www.cdc.gov/flu/protect/keyfacts.htm. Accessed April 8, 2018.

8. Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998;351:637-641.

9. Taylor LE, Swerdfeger AL, Eslick GD. Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine. 2014;32:3623-3629.

10. Agency for Toxic Substances & Disease Registry. Minimal risk levels for hazardous substances. Available at: https://www.atsdr.cdc.gov/mrls/mrllist.asp#34tag. Accessed April 8, 2018.

11. US Food and Drug Administration. Thimerosal and vaccines. Available at: https://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/UCM096228. Accessed April 8, 2018.

12. Hviid A, Stellfeld M, Wohlfahrt J, et al. Association between thimerosal-containing vaccine and autism. JAMA. 2003;290:1763-1766.

13. Centers for Disease Control and Prevention. Thimerosal in vaccines. Available at: https://www.cdc.gov/vaccinesafety/concerns/thimerosal/index.html. Accessed May 8, 2018.

14. Autism Speaks. Frequently asked questions. Available at: https://www.autismspeaks.org/what-autism/faq. Accessed April 8, 2018.

15. Agency for Toxic Substances & Disease Registry. Toxic substances portal-aluminum. Public Health Statement for Aluminum, CAS #7429-90-5. Available at: https://www.atsdr.cdc.gov/PHS/PHS.asp?id=1076&tid=34. Accessed April 8, 2018.

16. Children’s Hospital of Philadelphia. Vaccine ingredients-aluminum. Available at: www.chop.edu/centers-programs/vaccine-education-center/vaccine-ingredients/aluminum. Accessed April 8, 2018.

17. Orenstein W, Seib K. Mounting a good offense against measles. N Engl J Med. 2014;371:1661-1663.

18. Plans-Rubió P. The vaccination coverage required to establish herd immunity against influenza viruses. Prev Med. 2012;55:72-77.

19. Hall V, Banerjee E, Kenyon C, et al. Measles outbreak – Minnesota April-May 2017. MMWR Morb Mortal Wkly Rep. 2017;66:713-717.

20. The National Academies of Sciences Engineering Medicine. History of U.S. water and wastewater systems. Privatization of Water Services in the United States: an Assessment of Issues and Experience. Washington, DC: The National Academies Press; 2002:29-40. Available at: https://www.nap.edu/read/10135/chapter/4#35. Accessed May 7, 2018.

21. World Health Organization. Global vaccine safety. Six common misconceptions about immunization. Available at: http://www.who.int/vaccine_safety/initiative/detection/immunization_misconceptions/en/index1.html. Accessed May 7, 2018.

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31. Offit PA, Quarles J, Gerber MA, et al. Addressing parents’ concerns: do multiple vaccines overwhelm or weaken the infant’s immune system? Pediatrics. 2002;109:124-129.

32. Offit PA, Moser CA. The problem with Dr. Bob’s alternative vaccine schedule. Pediatrics. 2009;123:e164-e169.

33. Centers for Disease Control and Prevention. Flu vaccination coverage, United States, 2016-17 influenza season. Available at: https://www.cdc.gov/flu/fluvaxview/coverage-1617estimates.htm. April 8. 2018.

34. Walker TY, Elam-Evans LD, Singleton JA, et al. National, regional, state and selected local area vaccination coverage among adolescents aged 13-17 years – United States, 2016. MMWR Morb Mortal Wkly Rep. 2017;66:874-882.

35. Thomas TL. Cancer prevention: HPV vaccination. Semin Oncol Nurs. 2016:32:273-280.

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2. Don’t vaccines cause autism? Aren’t they toxic to the nervous system?

The largest setback to vaccination efforts in recent history was a 1998 study by Andrew Wakefield that suggested that vaccination (specifically the mercury [in the form of thimerosal] present in the measles, mumps, rubella [MMR] vaccine) was linked to the development of autism.⁸ This research was subsequently debunked,⁹ and the author of the 1998 study was stripped of his medical license for falsifying data. However, the damage to vaccination efforts had already been done.

Aluminum. Thimerosal is not the only agent that patients may find concerning. Some also worry about the aluminum content of vaccines. Aluminum works as an additive to boost the body’s immune response to a vaccine. It is used only in killed virus vaccines—not in live attenuated ones. The Agency for Toxic Substances and Disease Registry monitors minimum risk levels (MRLs) of aluminum and other compounds in potentially hazardous substances. The amount of aluminum in vaccines is far below the MRL for aluminum, which is 1 mg/kg/d.¹⁰(See “The facts about thimerosal and aluminum in vaccines.”^11-16)

SIDEBAR
The facts about thimerosal and aluminum in vaccines

Thimerosal

Ethyl-mercury was used (in the form of thimerosal) as a preservative to prevent bacterial and fungal contamination of vaccines. Since 2001, however, thimerosal has been removed from all US-licensed vaccines—except multidose vials of influenza vaccine—as a precautionary measure (and not for any reproducible evidence of harm). The multidose flu vial contains <0.01% thimerosal.¹¹

Ethyl-mercury is cleared from the body much more rapidly than methyl-mercury (the kind found in certain types of fish) and is less toxic.¹²

Since the removal of thimerosal from vaccines, the Centers for Disease Control and Prevention notes that the rates of autism have actually increased.¹³

Even Autism Speaks, the leading organization dedicated to advocacy for patients with autism and their families, denies a link between vaccines and autism.¹⁴

Aluminum

We are exposed to aluminum in products we use extensively every day, such as pots and pans, aluminum foil, seasonings, cereal, baby formula, paints, fuels, and antiperspirants.¹⁵

Infants are exposed to about 4.4 mg of aluminum in the vaccines typically administered in the first 6 months of life.¹⁶ However, infants typically ingest more than that during the first 6 months of life. Breast milk contains about 7 mg over 6 months; milk-based formulas contain about 38 mg over 6 months; and soy-based formulas contain about 117 mg over 6 months.¹⁶

Contine to: 3. I'm healthy. I never get sick. Why do I need vaccinations?