Communicating Vaccine Safety to the Public: An Expert Interview With Paul A. Offit, MD

Laurie Barclay, MD

May 06, 2009

May 6, 2009 — Editor's note: Healthcare professionals must educate parents that not vaccinating children poses serious risks to the health of individual children, as well as to the public, according to a presentation at the National Foundation for Infectious Diseases 12th Annual Conference on Vaccine Research (NFID-VR), held from April 27 to April 29 in Baltimore, Maryland.

To learn more about why there have been unsubstantiated concerns linking vaccination to mitochondrial diseases and how clinicians can best educate parents about vaccine safety, Medscape Infectious Diseases interviewed presenter Paul A. Offit, MD, chief of infectious diseases at the Children's Hospital of Philadelphia and professor of pediatrics at the University of Pennsylvania Medical School. Dr. Offit is this year's recipient of the Charles Mérieux Award, named for Dr. Charles Mérieux, a French scientist and pioneer in the development of vaccines to prevent infectious disease, and founder of a company that eventually became sanofi pasteur, the world's largest vaccine manufacturer.

Medscape: What evidence initially suggested a possible link between vaccination and mitochondrial diseases?

Dr. Offit: There is no evidence, really. The birth of that notion came from a settlement by the vaccine-injury compensation program. The case was that of Hannah Poling, daughter of John Poling, a neurologist. This girl had a mitochondrial enzyme defect and an encephalopathy as a result of that. I think that any child who has a mitochondrial enzyme deficiency and is stressed can worsen, and she got 5 shots, all at 1 time, containing vaccines to prevent 9 different infectious diseases. She got fever as a consequence of that, and as a result of that she worsened.

They were willing to compensate her for that, and I think that on the surface, that doesn't make sense, because there are many things that can cause fever, including ear infections, of which she had many, requiring tubes. I don't understand why they should compensate her for that, but they did, without ever going to an evidentiary hearing, where the facts would have been presented. The case was just simply conceded.

Medscape: Do you believe any special precautions should be observed regarding vaccination of children with mitochondrial diseases?

Dr. Offit: No, I believe the opposite, actually. Children who have mitochondrial diseases are at special risk when they develop infectious diseases. Vaccinations are a very, very mild form of infection. For most vaccines, it's just a matter of inducing immunity without inducing any symptoms, as opposed to natural infections, which can induce symptoms that are far greater and put children at far greater risk. These are the kinds of kids that most need to be immunized.

Medscape: How can parents be reassured about vaccination safety and encouraged to comply with recommendations?

Dr. Offit: They should go to reliable-source material, either the primary studies, which I think is difficult sometimes for people who don't have a background in epidemiology, microbiology, or virology, or to reliable Web sites, like the US Centers for Disease Control, the American Academy of Pediatrics, and the Vaccination Education Center. All of those have very good educational materials that are science-based, accurate, and up to date.

The Internet can be a source of very good and very bad information, and I think it's sometimes difficult for people to sort it out. Very often when parents say, "I did my research" on a particular vaccine, what they really mean is that they've looked at other people's opinions about vaccines on the Internet, which is not really the same thing.

Medscape: What should physicians do to make sure parents allow their children to be vaccinated?

Dr. Offit: Physicians should make sure that parents avail themselves of accurate information, and that they understand that the choice not to get vaccinated is not a risk-free choice — it's just a choice to take a different risk and a more serious risk. You could say that until a few years ago this was a theoretical problem, and that's true — if everybody in the country but you got a vaccine, you could say that, with the exception of the tetanus vaccine, you don't need to get a vaccine. Unfortunately, that's not the case. The fact is that there are many communities that are undervaccinated or unvaccinated, and we're now seeing the consequences of that.

Medscape: What consequences have there been from parents choosing not to vaccinate their children?

Dr. Offit: We've had pertussis outbreaks in relatively undervaccinated communities. The year 2008 saw the biggest measles outbreak we've had in more than a decade. At the end of last year and this year, we saw cases of Haemophilus influenzae type B meningitis, which is preventable by vaccine, but there were some parents who chose not to immunize their children . . . there was a death in Minnesota, there were 3 deaths in Philadelphia, as well as many more cases. The choice not to get that vaccine is not a risk-free choice; it is a choice to put your child at risk of a serious and fatal infection, and some of those children died because of that choice.

Medscape: What was the take-home message from your presentation about communicating science to the public?

Dr. Offit: The take-home message was that doctors, health professionals, and anyone with an interest in science and who understands science should get out there and do their part. That means explaining science and how it works to the public, because I think that scientific illiteracy has taken a toll on our children.

Parents are actually making a choice not to vaccinate their children. It's a bad choice that puts them at unnecessary risk, and I think that parents need to choose based on the best information. There is no venue too small for doctors and healthcare professionals to insert themselves and try to make sure that people understand what science is and how it works.

Medscape: What do you regard as the greatest challenges concerning vaccination strategies today?

Dr. Offit: You could argue that we are technologically more advanced than ever before in our history regarding vaccines. Recombinant DNA technology, adjuvant technology, our ability to understand what drives innate and adaptive immune responses, and advances in protein biochemistry and protein purification have allowed us to make safer and better vaccines than ever before. I think we're actually in a position where we can make vaccines against some of the most deadly and most difficult pathogens, like tuberculosis, human immunodeficiency virus, and malaria.

These advances put us on the brink of tremendous vaccines, which is at variance in many ways with the public's understanding of vaccines. I think at the same time that we can make the vaccines safer and better than ever before, we face a perception of vaccines as being dangerous by some parents, as actually being more harmful than helpful, to the point that they choose not to vaccinate their children. While we have tremendous technological opportunities, we also have tremendous challenges in getting the public to understand what vaccines do and what they don't do, and that is going to be the challenge for the next decade.

Dr. Offit is a coinventor and coholder of a patent on the rotavirus vaccine RotaTeq, from which he and his institution receive royalties, and he also serves on a scientific advisory board for Merck. The Merieux Award is underwritten by an unrestricted educational grant from sanofi pasteur. The NFID-VR conference is held in collaboration with the Albert H. Sabin Vaccine Institute; the Bill & Melinda Gates Foundation; the Center for Biologics Evaluation and Research of the Food and Drug Administration; the Centers for Disease Control and Prevention; the Center for Vaccine Development of the University of Maryland; Foundation Mérieux, International Association for Biologicals; the International Society for Vaccines; the International Vaccine Institute; the National Institute for Allergy and Infectious Diseases of the National Institutes of Health; the Netherlands Vaccine Institute; and the US Department of Agriculture.

National Foundation for Infectious Diseases 12th Annual Conference on Vaccine Research, April 27-29, 2009, Baltimore, Maryland.

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