Current Controversies in the USA Regarding Vaccine Safety

Archana Chatterjee; Catherine O'Keefe

Disclosures

Expert Rev Vaccines. 2010;9(5):497-502. 

In This Article

Abstract and Introduction

Abstract

As a result of the vaccines discovered in the 20th Century, parents and many healthcare providers of the 21st Century have limited or no experience with the devastating effects of diseases such as polio, smallpox or measles. Fear of disease has shifted to concerns regarding vaccine safety. Scientific evidence has refuted many of the misconceptions regarding vaccine safety; however, parental refusal of vaccines is increasing. Here we review six of the most prevalent controversies surrounding vaccine safety: the proposed causal relationship between receipt of the measles–mumps–rubella vaccine and autism; thimerosal as a potential trigger for autism; religious objection based on some vaccine viruses being grown in cell lines from aborted fetal tissues; parental worries that use of the human papillomavirus vaccine may lead to youth promiscuity; fears regarding the purported association between pertussis vaccination and adverse neurological outcomes; and concerns regarding too many vaccines overloading or weakening the infant immune system. Healthcare providers are ideally positioned to correct these misconceptions, but they must recognize and acknowledge parents' concerns, educate themselves on the latest scientific research that addresses these, and dedicate sufficient time to discuss vaccine safety with worried parents.

Introduction

Historical evidence suggests that there is a predictable inverse relationship between the levels of vaccine-preventable diseases and safety concerns, with safety concerns likely to emerge as first-hand experience with vaccine-preventable diseases decreases.[1] Today, vaccines represent one of the most important medical advances of all time and are responsible for preventing several vaccine-preventable diseases, and untold human suffering and disability.[101] As a consequence of the vaccine discoveries of the 20th Century, parents and many healthcare providers of the 21st Century have limited or no experience with the devastating effects of diseases such as polio, smallpox or measles. This has contributed to an uneasy relationship between the lay public and stewards of public health. In a recent survey of pediatricians and family practitioners, 11% of the physicians did not recommend to parents that children receive all available vaccines.[2] Thus, controversies surrounding safety have clouded the successes reaped by these life-saving vaccines. Fear of disease has shifted to fear of vaccine safety. Ironically, vaccines have become victims of their own success.

Scientific evidence has refuted many of the misconceptions regarding the safety of vaccines;[3] however, a distressing increase in parental refusal of vaccines has been reported.[4,5,6] A 2001–2002 National Immunization Survey indicated that 1% of parents believe vaccines are unsafe and another 6% have a neutral opinion on vaccine safety. Both groups had similar low vaccination coverage.[4] The 2003–2004 National Immunization Survey revealed an increase in vaccine refusal rates to 6%, with a total of 28.3% of respondents indicating that they were unsure or delaying vaccines due to concerns about vaccine safety.[7] Recent outbreaks of measles, Haemophilus influenzae type b invasive disease and pertussis have been attributed to vaccine refusal resulting in underimmunized infants and children.[8–11] These outbreaks underscore the need for continued efforts to educate the community regarding the safety and efficacy of currently licensed vaccines.

In this review, current common vaccine controversies in the USA will be addressed. In addition, the extant scientific evidence will be discussed within the context of the ongoing public health debate regarding the recommended vaccination schedule for infants and children.

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