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.

22. The history of vaccines. Human cell strains in vaccine development. Available at: https://www.historyofvaccines.org/content/articles/human-cell-strains-vaccine-development. Accessed April 8, 2018.

23. The National Catholic Bioethics Center. Frequently asked questions. Available at: https://www.ncbcenter.org/resources/frequently-asked-questions/use-vaccines/. Accessed April 8, 2018.

24. Shimabukuro TT, Nguyen M, Martin D, et al. Safety monitoring in the vaccine adverse event reporting system (VAERS). Vaccine. 2015;33:4398-4405.

25. Foster S. Rotavirus vaccine and intussusception. J Pediatr Pharmacol Ther. 2007;12:4-7.

26. Mistry RD, Fischer JB, Prasad PA, et al. Severe complications of influenza-like illnesses. Pediatrics. 2014;134:e684-e690.

27. McNeil MM, Weintraub ES, Duffy J, et al. Risk of anaphylaxis after vaccination in children and adults. J Allergy Clin Immunol. 2016;137:868-878.

28. McLaughlin JM, McGinnis JJ, Tan L, et al. Estimated human and economic burden of four major adult vaccine-preventable diseases in the United States, 2013. J Prim Prev. 2015;36:259-273.

29. Centers for Disease Control and Prevention. Vaccines for Children (VFC) Program. Available at: https://www.cdc.gov/features/vfcprogram/index.html. Accessed April 8, 2018.

30. Plotkin S, Gerber JS, Offit PA. Vaccines and autism: a tale of shifting hypotheses. Clin Infect Dis. 2009;48:456-461.

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.

36. Centers for Disease Control and Prevention. Estimating seasonal influenza-associated deaths in the United States. Available at: https://www.cdc.gov/flu/about/disease/US_flu-related_deaths.htm. Accessed May 8, 2018.

37. Wong KK, Jain S, Blanton L, et al. Influenza-associated pediatric deaths in the United States: 2004-2012. Pediatrics. 2013;132:796-804.

38. Centers for Disease Control and Prevention. Seasonal influenza vaccine effectiveness, 2005-2018. Available at: https://www.cdc.gov/flu/professionals/vaccination/effectiveness-studies.htm. Accessed April 8, 2018.

39. Centers for Disease Control and Prevention. Influenza (flu). Flu vaccine and people with egg allergies. Available at: https://www.cdc.gov/flu/protect/vaccine/egg-allergies.htm. Accessed April 8, 2018.

40. Centers for Disease Control and Prevention. For parents: vaccines for your children. HPV vaccine for preteens and teens. Available at: https://www.cdc.gov/vaccines/parents/diseases/teen/hpv.html. Accessed April 8, 2018.

41. Centers for Disease Control and Prevention. Vaccines and preventable diseases. HPV vaccine recommendations. Available at: https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html. Accessed May 7, 2018.

42. Cutts FT, Franceschi S, Goldie S, et al. Human papillomavirus and HPV vaccines: a review. Bull World Health Organ. 2007;85:719-726.

43. De Vincenzo R, Conte C, Ricci C, et al. Long-term efficacy and safety of human papillomavirus vaccination. Int J Womens Health. 2014;6:999-1010.

44. McInerney KA, Hatch EE, Wesselink AK. The effect of vaccination against human papillomavirus on fecundability. Paedeatr Perinat Epidemiol. 2017;31:531-536.

45. Chao C, Klein NP, Velicer CM, et al. Surveillance of autoimmune conditions following routine use of quadrivalent human papillomavirus vaccine. J Intern Med. 2012;271:193-203.

46. Vichnin M, Bonanni P, Klein NP, et al. An overview of quadrivalent human papillomavirus vaccine safety: 2006-2015. Ped Infect Dis J. 2015;34:983-991.

47. Bednarczyk RA, Davis R, Ault K, et al. Sexual activity-related outcomes after human papillomavirus vaccination of 11-to-12-year-olds. Pediatrics. 2012;130:798-805.

SIDEBAR
Influenza vaccine: Patient-friendly talking points

Some people think that getting the flu is no big deal. While it is true that the flu takes a greater toll on the very young and very old, the chronically ill, and the immune compromised, even healthy people can become seriously ill or die. The Centers for Disease Control and Prevention estimates that the flu is responsible for 140,000 to 720,000 hospitalizations and 12,000 to 56,000 deaths in the United States every year.⁷ Of those who die from the flu, approximately 80% did not receive a flu shot.³⁶ Of children who died from the flu between 2004 and 2012, more than 40% had no risk factors for complications.³⁷
The flu shot is a killed virus vaccine, so it can't give you the flu. People sometimes feel under the weather (achy, low-grade fever) after a vaccine, but this is considered normal and evidence that your body's immune system is "revving up."
It takes 2 weeks before the vaccine becomes effective so a person can still get the flu during that time. This is why it is so important to get the vaccine earlier in the fall, before the flu season takes hold.
The "stomach flu" is not the flu. The flu vaccine does not protect against the "stomach flu" or other flu-like illnesses.
The flu vaccine is not perfect. It is an educated guess as to which strains will be circulating that year. (At its best, the flu vaccine is about 60% effective.³⁸) However, it makes the chance of getting the flu less likely and significantly decreases the odds of severe complications/death.
Egg allergies are no longer a reason to avoid the flu vaccine. There is an egg-free vaccine called Flublok (for those ≥18 years of age). In 2016-17, the Advisory Committee on Immunization Practices changed the recommendations for flu vaccine in egg-allergic people. The recommendations say that if reactions are mild, or you can eat cooked eggs without a problem, you can receive a flu vaccine. If you have severe reactions, such as trouble breathing or recurrent vomiting, you can still receive the flu vaccine, but must be monitored by a health care provider who can recognize and respond to a severe allergic reaction.³⁹

Continue to: 3. Why don't we adhere to Dr. Sears' vaccine schedule?