Responding to 7 Common Parental Concerns About Vaccines & Vaccine Safety Immunization Initiatives Newsletter - April 2005
Over the years, studies have identified 7 common parental concerns about vaccines and immunization. The following information is designed to help pediatricians and other child health professionals address these concerns in the practice setting. Additional resources, including books, articles, and Web links to patient-education materials are provided. 1. Use Of Thimerosal As An Additive In Vaccines Some parents have expressed concerns about a potential link between health problems, particularly autism, and vaccines containing thimerosal. Thimerosal is a preservative that contains a form of mercury (organomercurial). Beginning in the 1930s, thimerosal was used in very small amounts as a preservative in vaccines. Thimerosal is effective in preventing bacterial and fungal contamination, particularly in opened multi-dose vaccine containers. In 1999, the Public Health Service agencies and the AAP recommended that thimerosal be taken out of vaccines as a precautionary measure. By the end of 2001, all routine pediatric vaccines contained no thimerosal or only trace amounts (some influenza and Td vaccines). There is no convincing evidence of harm caused by the small amounts of thimerosal in vaccines, except for minor effects like swelling and redness at the injection site due to sensitivity to thimerosal. Prior to the recent initiative to reduce or eliminate thimerosal from childhood vaccines, the maximum cumulative exposure to mercury via routine childhood vaccinations during the first six months of life was 187.5 micrograms. With the newly formulated vaccines, the maximum cumulative exposure during the first six months of life will now be less than 3 micrograms of mercury; this represents a greater than 98 percent reduction in the amount of mercury a child would receive from vaccines in the first six months of life. [Influenza (flu) vaccine is not given until six months or older.] Resources Offit PA, Jew RK. Addressing parents' concerns: do vaccines contain harmful preservatives, adjuvants, additives, or residuals? Pediatrics. 2003; 112: 1394 – 1397. AAP. What Parents Should Know About Thimerosal. Available at: http://www.aap.org/immunization/families/ingredients.html#thimerosal CDC. Thimerosal Preservative and Routinely Recommended Childhood Vaccines. Available at http://www.aap.org/immunization/families/ingredients.html CDC. Vaccine Safety Datalink (VSD) Study, Safety of Thimerosal-Containing Vaccines: A Two-Phased Study of Computerized Health Maintenance Organization (HMO) Databases. Available at http://www.cdc.gov/nip/vacsafe/concerns/thimerosal/researchQAs.htm#vsdres CDC. Mercury and Vaccines (Thimerosal). Available at http://www.cdc.gov/nip/vacsafe/concerns/thimerosal/default.htm 2 . MMR Vaccine and Autism Autism is a common developmental disability, affecting an estimated 1 in 500 children. Because the MMR vaccine is first given at age 12-15 months, and the first signs of autism (ie, poor social interaction and speech, repetitive behaviors, etc) often appear at 15-18 months of age, concerns have been raised about a possible link between the vaccine and the development of autism. Studies conducted in the US and Europe have found no association between the MMR vaccine and autism. Over the years, the Institute of Medicine and the AAP have organized several panels of independent scientists to study MMR and autism – again, all concluded no association between MMR and autism. Research on this topic continues in an effort to assure the safety of vaccines. Although the cause of autism is unknown in most instances, the theory favored by many experts is that it is a genetically based disorder that occurs before birth. Evidence that genetics is an important, but not exclusive, cause of autism includes a 3-8% risk of recurrence in families with one affected child. Research on the cause of autism is ongoing. Resources Halsey NA, Hyman SL, and the Conference Writing Panel. Measles-Mumps-Rubella Vaccine and Autism Spectrum Disorder: A Report From the New Challenges in Childhood Immunizations. Pediatrics. 2001; 107: 84 AAP. MMR Vaccine and Autism: What Parents Need to Know. Available at: http://www.aap.org/immunization/families/autismfacts.html IAC. Does MMR Cause Autism? Examine the Evidence. Available at: http://www.immunize.org/catg.d/p4026.pdf CDC. Vaccines and Autism Theory. Available at: http://www.cdc.gov/vaccinesafety/concerns/mmr_autism_factsheet.htm 3. Importance Of Hepatitis B Vaccine In Infancy Some parents believe that the hepatitis B vaccine should not be given to infants and children since it is associated with high-risk behavior including intravenous drug use and sexual activity. The hepatitis B vaccine is the best protection a child can have against a dangerous and lifelong disease. Before the vaccine was introduced, 20,000 children under the age of 10 became infected each year. Vaccinating early against hepatitis B assures children's immunity when they are the most vulnerable to the worst complications of the disease and before they enter the high-risk adolescent years. Because of common scrapes, falls, and lack of personal hygiene, children (particularly in child care settings) are more exposed to bodily fluids than some adults. Infants who catch hepatitis B from their mothers at birth are at a greater risk of suffering a premature death from liver cancer or liver failure later in life. Resources AAP. Summary - AAP Preference for Birth Dose of Hepatitis B. Available at: http://www.aap.org/immunization/illnesses/hepb/hepb.html IAC. Give the Birth Dose: Hepatitis B Vaccine at Birth Saves Lives. Available at: http://www.immunize.org/catg.d/p2125.pdf CDC. Hepatitis B. Available at: http://www.cdc.gov/nip/vacsafe/concerns/hepB/default.htm 4. Importance Of Pneuomococcal Conjugate Vaccine Prior to the pneumococcal vaccine, pneumococcus bacteria was the leading cause of bacterial meningitis infection in children under 5. Meningitis symptoms in children are less obvious than in adults and often go undetected and untreated. It is important to vaccinate children to protect them from this uncertainty. Meningitis, an inflammation of the brain and spinal cord, can lead to brain damage, mental retardation, and even death. Pneumococcal conjugate vaccine provides superior protection against this serious and deadly infection. Resources Overturf GD, and the Committee on Infectious Diseases. Technical Report: Prevention of Pneumococcal Infections, Including the Use of Pneumococcal Conjugate and Polysaccharide Vaccines and Antibiotic Prophylaxis. Pediatrics. 2000; 106:367-376 IAC. Pneumococcal Disease in Children. Available at: http://www.vaccineinformation.org/pneumchild/index.asp CDC. PCV7 Vaccine Q&A. Available at: http://www.cdc.gov/nip/vaccine/pneumo/pneumo-vacfaqs.htm 5. Importance of Meningococcal Conjugate Vaccine Meningococcal disease is caused by bacteria that infect the bloodstream, lining of the brain, and spinal cord, often causing serious illness. Every year in the US 1400-2800 people get meningococcal disease. Ten to 14% of people with meningococcal disease die, and 11-19% of survivors have permanent disabilities (such as mental retardation, hearing loss, and loss of limbs). In 2005, a new quadrivalent conjugate vaccine to protect against invasive meningococcal disease was licensed and recommended for children 11-12 and teens entering high school, as well as college freshmen living in dormitories. The vaccine is licensed for use in adolescents and adults aged 11-55 years. A quadrivalent polysaccharide vaccine has been available in the US for many years; however, it has not been recommended for routine use. Resources CDC. Meningococcal Vaccines Vaccine Information Statement. Available at: http://www.cdc.gov/nip/publications/VIS/vis-mening.pdf AAP. Revised Policy Statement on Meningococcal Vaccine. Coming Soon! 6. Relative Danger of Influenza (need for yearly vaccination) Some parents question the need for a yearly dose of the flu vaccine. They believe that influenza is a relatively mild disease (one that they have had and have survived) and that the risk of vaccination outweighs the risk of the disease. Parents also may have concerns about thimerosal in the flu vaccine (see above). Influenza is a serious disease, and people of any age can get it. In an average year, the flu causes 36,000 deaths and 200,000 hospitalizations in the US. The "flu season" is usually from November-April each year. An annual flu vaccine (either the flu shot or the nasal-spray flu vaccine [in recommended age groups]) is the best way to reduce circulation of the flu. Annual shots are necessary because flu viruses change from year to year. This means that a person can get the flu more than once during their lifetime. The immunity that is built up from having the flu caused by one virus strain doesn't always provide protection when a new strain is circulating. In other words, a vaccine made against flu viruses circulating last year may not protect against the newer viruses. Further, immunity to the disease declines over time and may be too low to provide protection after one year. Resources CDC. Questions & Answers: Thimerosal-Containing Influenza Vaccine. Available at: http://www.cdc.gov/flu/about/qa/thimerosal.htm CDC. Influenza Web site. Available at: http://www.cdc.gov/flu AAP Childhood Immunization Support Program. Influenza Guidance Web site. Available at: http://www.aap.org/immunization/pediatricians/influenzaguidance.html 7. Relative Danger of Varicella Vaccine Some parents question the need for the varicella vaccine. Like influenza, they believe that chickenpox is a harmless illness and that the risk of vaccination outweighs the risk of the disease. In 1999, an average of 1 child a week died in the US from complications of chickenpox. These complications include encephalitis, a brain infection; severe staph and strep secondary infections (flesh-eating strep and toxic shock syndrome); hepatitis; and pneumonia. Before the vaccine, there were 4 million cases of chickenpox, 11,000 hospitalizations, and 100 deaths per year in the US. The varicella vaccine prevents chickenpox in about 70-90% of people who get the shot and prevents severe chickenpox in over 95%. Resources CDC. Varicella Vaccine Web site. Available at: http://www.cdc.gov/nip/vaccine/varicella/default.htm AAP Committee on Infectious Diseases. Varicella Vaccine Update. Pediatrics. 2000;105:136-141. Available at: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;105/1/136.pdf Additional Resources AAP Childhood Immunization Support Program. Making the Decision. Available at: http://www.aap.org/immunization/families/deciding.html Immunization Action Coalition (IAC). Responding to Concerns About Vaccines. Available at: www.immunize.org/concerns/index.htm CDC. Six Common Misconceptions About Vaccinations and How to Respond to Them. Available at: www.cdc.gov/nip/publications/6mishome.htm Email us with questions about how to respond to other parental concerns at: cispimmunize@aap.org | 
