Controversy surrounding an autism-vaccinelink has elicited considerable news media attention (Dixon & Clarke, 2012).Fear of disease has shifted to concerns regarding vaccine safety. Scientificevidence 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 themeasles-mumps-rubella (MMR) vaccines with autism as a potential trigger. Familyphysicians and advanced care providers should be knowledgeable about vaccines inorder to inform their patients of the benefits of immunization and any provenrisks. If immunization rates continue to fall, the incidence ofvaccine-preventable illnesses may rise.
PubMed, Embase, and CINHAL were used toconduct 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 basedresearch regarding the misconceptions, benefits of immunization, and scientificindications surrounding vaccine safety was formulated. Search criteria werelimited to English and reviewed articles published within the last 8 years toyield the most landmark evidence.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 ofvaccinations and beliefs in their successes.
The purpose of this assignment isto highlight the debate regarding differing perspectives on integrative healthand the influence on the care we as advanced practice nurses provide topatients. I will specifically discuss the autism-vaccine controversy on vaccinesafety perceptions and behavioral intentions. On September 24, 2008, Oprah Winfreyinterviewed Jenny McCarthy about her book MotherWarriors: A Nation of Parents Healing Autism Against All Odds. McCarthy’sson had been diagnosed with autism and she did not have trust in mainstreamproviders 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 onautism 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 autismshot, isn’t it?’. Preceding the MMR shot, she acknowledged a noticeable changein her son ultimately faulting the MMR vaccine. Further into the interview,Oprah validates what McCarthy speaks on by stating, “She wrote the book, sheknows what she is talking about” (Offit,2013).
Using thesearch criteria and keywords stated above, five articles were reviewed forcredibility and reliability. Onearticle in particular analyzed data from a case control study conducted in 3managed care organizations (MCOs) of 256 children with autism spectrum disorder(ASD) and 752 control children matched on birth year, sex, and MCO. ASDdiagnosis were validated through standardized in-person evaluations. Exposureto antibody-stimulating proteins and polysaccharides from vaccines weredetermined by summing the antigen content of each vaccine received, as obtainedfrom immunization registries and medical records. Potential confounding factorswere ascertained from parents’ interviews and medical charts.
Conditionallogistic regression was used to assess associations between ASD outcomes andexposure to antigens in selected time periods. The results of this study provedwith a confidence interval of 95% that there is no increased risk for ASD withvaccinations (DeStefano, Price, & Weintraub, 2013).Another set of investigators studied 1.8million Finnish children who received almost 3 million doses of MMR vaccineover 14 years and found no vaccine-associated cases of autism.
In California,retrospective analyses of MMR immunization coverage and children with autismalso did not suggest an association between MMR vaccine and an increasedincidence of autism (Sanford, 2002). Subsequently,results of several large population and ecologic-based studies have failed toprovide any support for McCarthy’s theory that vaccinations indeed causeautism. Further details about this controversy and autism research have beenpublished by the Institute of Medicine in a report on vaccine safety stating,”the committee concludes that the evidence favors rejection of a causalrelationship between MMR vaccine and autism” (Chatterjee & O’Keefe, 2010).Before vaccines, Americans could expect thatevery year diseases such as diphtheria, rubella, polio, and mumps would impairor possibly kill thousands of children. In the developed world, vaccines havealmost completely eliminated these diseases (Offit, 2013). Parent’s today are overwhelmed withvaccine controversies and decisions they are facing, affecting their children’shealth and well-being.
McCarthy’s public denouncement of vaccines along withinternet blogs hosted by anti-vaccine activists influence many parents againstvaccinating their children. When Oprah gave credence to McCarthy’s anti-vaccinemessage, it had an effect and it did a lot of harm. Americans have witnessed anincrease in hospitalizations and deaths from diseases like whooping cough,measles, mumps, and bacterial meningitis because some parents have become morefrightened by vaccines than by the diseases they prevent.
Although McCarthydoesn’t mention it in her books, researchers have shed a great deal of light onthe causes of autism. Given our understanding of the disorder, McCarthy’stheory to avoid vaccinating children to lessen the risk of autism is not onlyuseless, it’s dangerous (Offit,2013). Parents who choose not to vaccinateare not lessening their children’s risk of autism; instead they are increasingtheir child’s risk of suffering from preventable diseases (Offit, 2013). Therefore, it is imperative thathealthcare providers are prepared to respond to patient and parent anxietiesrelated to emerging concerns regarding vaccine safety.
