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RUNNING HEAD: Rumor spreads disease: what is the vaccine-autism controversy and how does this hurt pediatric

patients?

Rumor spreads disease: What is the vaccine-autism controversy and how does this hurt pediatric patients? Vivian Pham University of the Sciences

Rumor spreads disease: what is the vaccine-autism controversy and how does this hurt pediatric patients?

Abstract

In 1998, Andrew Wakefield seemed to confirm the fears of many parents that the MMR vaccine caused autism. His study gave many parents of autistic children the answer, the confirmation that their child had been hurt, confirming their belief that their child who was perfect upon birth became sick after a vaccine. Follow up studies proposed that toxins in the vaccines, such as mercury, specifically caused the autism spectrum diseases. However, hundreds of studies have proven the opposite, that any proposed connection of an approved vaccine to autism is false. Despite this, many people still believe that vaccines are dangerous, choosing to opt-out of immunization requirements. These decisions have been a source of concern for many researchers and physicians, as diseases that should have been eradicated are resurging and patients that should have been protected from these illnesses have become infected or even killed. Vaccinations have been advertised as an essential medical procedure, but controversy has changed the way some patients trust the system, inciting consequences for everyone, especially young children.

Rumor spreads disease: what is the vaccine-autism controversy and how does this hurt pediatric patients?

Rumor spreads disease: what is the vaccine-autism controversy and how does this hurt pediatric patients? Introduction Nine months, enclosed in the safety of the mother's womb, ends within a matter of hours. When babies are born, they are exposed to millions of new organisms in the air, on surfaces, and even from other people such as their doctors, nurses, or parents. As a new parent, it is natural to have the instinctual impulse to shield the baby from every threat in the world. But how can someone protect a baby from threats as tiny as bacteria or viruses? For over 30 years, vaccines have been the answer to these fears. According to the Center of Disease Control (CDC), essential immunizations needed by children between birth and age six include 14 different vaccines such as the DTaP vaccine and the MMR vaccine, both of which combined immunize children to diphtheria, tetanus, and pertussis and measles, mumps, and rubella, respectively (CDC, 2013). Most of these diseases are classified as nearly eradicated from most of the developed world, but are easily contractible and have high outbreak risk. Because most of these diseases are spread by simple contact or even by breathing, they can grow quickly no matter how rare. However, these childhood diseases are not as prevalent today, leading many parents to opt not to vaccinate their children, creating an "immunization gap" that puts these children, and even adults, at risk. For example, instead of measles becoming completely eradicated by the end of the 20th century as predicted, outbreaks hit cities all over the United States in 1989, resulting in over five thousand cases and over one hundred deaths (Yost, Childhood Immunizations, 1993).

Rumor spreads disease: what is the vaccine-autism controversy and how does this hurt pediatric patients?

Since the late 1980s and 1990s, as the spread of these old diseases became more controlled and health in children strengthened, the need for vaccinations came into question. People looked for reasons why they should give a newborn such a heavy onslaught of vaccine dosages, fearing it would be harmful. In a time where autism was on a rise and no explanation could be given, people turned to vaccines for the blame. Whether these vaccines are dangerous or not, these questions have affected the decisions of parents and affected the spread and control of diseases around the country.

A Review While many doctors and researchers would agree that vaccines are extremely necessary, some researchers have argued that vaccines today prove to be more dangerous than helpful, citing toxins such as aluminum or preservatives causing neural damage, leading to psychological diseases on autism spectrum. One of the leading researchers against vaccines is Andrew Wakefield, who published a controversial study in 1998, causing many people, especially parents to begin to question the healthfulness of vaccines. However, several studies, such as that by Gerber and Offit of the Division of Infectious Diseases from The Children's Hospital of Philadelphia, determined many flaws within Wakefield's study. These studies have led to the eventual retraction by Wakefield, but it did not end the speculation on vaccines and its possible connection to autism. In addition, a study by S. Bernard et al. brought light to more dangers in vaccines. In opposition, the CDC and other researchers have claimed that these ingredients are not high enough dosages to be toxic or are completely harmless. Some researchers have stated

Rumor spreads disease: what is the vaccine-autism controversy and how does this hurt pediatric patients?

that these vaccines have conclusively done more harm than good to children, while others completely reject any indication of these vaccines being dangerous.

Are vaccines more harmful than helpful? Billions of microbes surround a newborn baby. Dirt and dust cover the hair and hands of rowdy toddlers. Yet, parents choose to inject more than a dozen different vaccines, some of which contain the live or weakened virus, directly into the body of their children, forcing the immune systems to work even harder, risking sickness if at any point the pressure becomes too much. In the late 1980s and throughout the 1990s, children at this young age, while largely protected from influenzas or measles, started to develop in large numbers a disease known as autism, which at the time, and still today, not completely understood. As diagnoses of autism increased in this age group, some people began to question if these increased cases were caused by adverse effects of vaccines. Andrew Wakefield is recognized as one of the first researchers to propose the notion of vaccines being harmful, causing autism and other health issues in children. According to Wakefield, vaccines, specifically the MMR vaccine, causes gastrointestinal irritation that led to "translocation of usually nonpermeable peptides to the bloodstream and, subsequently, to the brain, where they affected development," claiming that the brain subsequently becomes inflamed, also known as encephalitis, caused enough damage to cause autism development (as cited in Gerber & Offit, 2009). Many anti-vaccination supporters, such as those who write for Natural News, a media source highly disregarded as a credible source, recite this proposed connection as proof that the MMR vaccine directly causes autism. Although Natural News is

Rumor spreads disease: what is the vaccine-autism controversy and how does this hurt pediatric patients?

widely renounced, it still has a very large following, with almost 50,000 websites linking people to their articles (Alexa.com), making their interpretations spread and influence the ideas of other anti-vaccine supporters. In 1986, the National Vaccine Injury Compensation Program (NVICP) was created as a precautionary program, as a way to settle injury cases without the long and expensive court battles. The NVICP developed a table of vaccines and the common injuries cited and the common timeline cited. According to the NVICP, "if the first symptom of these injuries/conditions occurs within the listed time periods, it is presumed that the vaccine was the cause of the injury or condition" and compensation is given. However, anti-vaccinators see this as an admission that vaccines are dangerous. In 2006, parents of Ryan Mojabi, a 10-year-old boy, claimed that he experienced encephalitis, a condition that causes brain damage and appealed to the U.S. Department of Health and Human Services for compensation (Mojabi, 2006). The NVICP's accepting of this appeal brought on an onslaught of anti-vaccinators. Natural News stated that this acceptance is a clear admission by the U.S. government of the MMR vaccine causing autism. In a publication by Messing, Rubenstein, and Nestler (2012), it is suggested that autism spectrum disorders are actually caused largely by genetic inheritance of mutated genes (Genetics). Gene mutations cause irregular growth in the brain that affects the way it is shaped and the way it functions. Encephalitis may cause many physical damages to the brain and alter the way it works, but these deformities are damages, not a deformity developed upon birth (Messing et al., 2012). The damages by encephalitis can cause problems or destroy the brain's normal function, but with autism, these differences are the brain's "normal" functions. An autistic brain is different from a normal brain, but it is not necessarily damaged. In addition, according to

Rumor spreads disease: what is the vaccine-autism controversy and how does this hurt pediatric patients?

researchers Gerber and Offit, the unsupported connection between the intestinal issues with autism by Wakefield were improbable because "peptides traveling from the intestine to the brain have never been identified" (p. 456, 2009). Researchers are currently leaning on this genetic theory as the pathology of autism spectrum disorder, and although it may not be complete or completely developed, many researchers have dismissed the notion of brain damage being the sole source for the development of autism.

Controversial Ingredients Since Wakefield's retraction of his peptide-brain-inflammation proposal, researchers have suggested new sources of inflammatory damage. Some ingredients of vaccines, such as mercury or aluminum are the toxins that cause these damaging neurological developments and abnormalities that lead to autistic behaviors in these children. In 2001, researchers Bernard, Enayati, Redwood, Roger, & Binstock proposed that a preservative in vaccines, thimerosal, contained toxic mercury, which can "cause immune, sensory, neurological, motor, and behavioral dysfunctions similar to traits defining or associated with autism," causing a protest among parents and other anti-vaccinators that vaccines are unnatural and dangerous (p. 462). According to Dorea, Farina, and Rocha (2013), thimerosal can produce ethylmercury (etHg) in the body, which in an animal study, proved to break down easily "to Hg2+, which has limited access to the brain and typically targets the kidneys," not the brain (p.706). Since, the mercury ion does not usually affect the brain, the notion of thimerosal directly causing autism is unfound.

Rumor spreads disease: what is the vaccine-autism controversy and how does this hurt pediatric patients?

In addition, a paper by Gerber & Offit claims that mercury poisoning causing autism is "biologically implausible" as patients of mercury poisoning have a completely different behavioral profile compared to those with autism spectrum disease (p. 458, 2009). For example, physically, autistic patients and mercury-poisoned patients experience different head sizes; psychologically, autistic patients can be high functioning, focusing in minute details that make them excel in certain fields but mercury-poisoned patients usually lose functionality in their brains, experiencing spasticity (Nelson & Bauman, p. 674, 2003). In a study by Stehr-Green et al., the researchers addressed the concerns over the preservative thimerosal in vaccines by comparing data from three areas, California, Sweden, and Denmark, and paralleled these statistics of autism cases to data pertaining to the amounts of thimerosal used in vaccines (2003). Stehr-Green et al. concluded that the correlation between rise in autism and thimerosalcontaining vaccines was not strong (2003). Finally, even if these ingredients caused extreme adverse effects or were present in vaccines are toxic levels, the inflammatory damage claimed still has not been conclusively supported as the cause of autism spectrum diseases.

Reasons Why Vaccines Are Essential Despite these controversies, vaccines are required all over the country, especially children entering school or healthcare providers working in proximity to patients. According to

Rumor spreads disease: what is the vaccine-autism controversy and how does this hurt pediatric patients?

Bardenheier et al., more than ninety-percent of the parents still believe that vaccines are important (Parental Beliefs and Practices Associated with Vaccinations, 2004). For decades, vaccines have proven to work: people no longer contract polio in the United States, measles is nearly eradicated, and seasonally, people avoid extreme flu symptoms simply by receiving a tiny vaccine shot. Vaccines not only protect the patient from contracting an illness, it also prevents the ill from hurting anyone else. The controversies that spread about vaccines, piled on top of ignorance to how quickly some diseases can bounce back, are hurting not only adults but also, and especially, children. Children are around other children every day, either at school, at a sports game, or even within their own homes and communities. Children are messy, picking up interesting things off the ground, touching almost anything and, subsequently, touching their own and each other's faces and hands. In 2010, an outbreak of pertussis, also known as whooping cough, infected thousands of people in California, killing ten infants who had not yet reached the age to even receive the vaccination (Shute, 2013). According to Atwell et al., the areas where nonmedical exemptions to vaccines were filed were significant enough to count non-vaccination as a factor to the spread of pertussis in 2010 (p. 624, 2013). Because the vaccination numbers for the disease dropped, the resurgence and spread hit communities, infecting not only the unprotected but also the protected, since the pertussis vaccine received by older children and adults were not updated enough to fight the new pertussis (Shute, 2013).

Conclusion Bacteria and viruses constantly battle the human immune system, fighting to break in for somewhere to replicate and grow. The immune system is strong, however, usually capable to

Rumor spreads disease: what is the vaccine-autism controversy and how does this hurt pediatric patients?

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keeping these intruders out. Vaccines have been the extra boost, preparing the immune system for the real thing so that it can fight harder to keep the body healthy. When a major disease hit children all over the country, seeming to spread quickly without a cure imagined, people blamed vaccines. It was a possible correlation: the perfect babies suddenly becoming autistic after it received those shots with unpronounceable chemicals. People forgot that these vaccines have saved lives all over the world for years, eradicating some of the biggest threats to human health. While scientific data has supported again and again the safety of vaccines and doctors and researchers have nearly concluded the genetic linkage of autism, some still deny the vaccines, harming more than anyone, even doctors, could anticipate.

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References Alexa Internet (n.d.) [Data Set]. Retrieved from http://www.alexa.com/siteinfo/naturalnews.com Autism and Andrew Wakefield. (2013). American Academy of Pediatrics. Retrieved from www2.aap.org/immunization/families/autismwakefield.html Atwell, J.E., Otterloo, J., Zipprich, J., Winter, K., Harriman, K., Salmon, D.A., Halsey, N.A., & Omer, S.B. (2013). Nonmedical vaccine exemptions and pertussis in California 2010. Pediatrics. doi: 10.1542/peds.2013-0878 Bardenheier, B., Yusuf, H., Schwartz, B., Gust, D., Barker, L., & Rodewald, L. (2004). Are parental vaccine safety concerns associated with receipt of measles-mumps-rubella, diphtheria and tetanus toxoids with acellular pertussis, or hepatitis B vaccines by children? Archives of Pediatric & Adolescent Medicine,158(6):569-575. Retrieved from http://archpedi.jamanetwork.com/article.aspx?articleid=485738 Benson, J. (2013). Breaking: courts discreetly confirm MMR vaccine causes autism. Natural News. Retrieved from http://www.naturalnews.com/041897_MMR_vaccines_autism_court_ruling.html# Bernard, S., Enayati, A., Redwood, L., Roger, H., Binstock, T. (2001). Autism: a novel form of mercury poisoning. Medical Hypotheses, 56,4:462-471. doi: 10.1054/mehy.2000.1281, Dorea, J., Farina, M., & Rocha, J. (2013). Toxicity of ethylmercury (and thimerosal): a comparison with methylmercury. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/jat.2855/pdf Mojabi v. Department of Health and Human Services. (2006). Retrieved from http://www.uscfc.uscourts.gov/sites/default/files/opinions/CampbellSmith%20Mojabi%20Interim%20Fees.pdf

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Messing, R., Rubenstein, & J., Nestler, E. (2012). Autism spectrum disorders. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, & J. Loscalzo, (Eds.), Harrison's principles of internal medicine. Retrieved from http://www.accessmedicine.com/content.aspx?aID=9112131&searchStr=autistic+disorde r Nelson, K.B. & Bauman, M.L. (2003). Thimerosal and autism? Pediatrics (Vol. 111: 674-679) doi: 10.1542 Shute, N. (2013). Vaccine refusals fueled California's whooping cough epidemic. NPR. Retrieved from http://www.npr.org/blogs/health/2013/09/25/226147147/vaccine-refusalsfueled-californias-whooping-cough-epidemic Stehr-Green, P., Tull, P., Stellfeld M., Mortenson, P., Simpson, D. (2003). Autism and thimerosal-containing vaccines: Lack of consistent evidence for an association. American Journal of Preventative Medicine, 25(2):101-106. Retreived from http://www.sciencedirect.com Recommended immunizations for children from birth through 6 years old. (2013). CDC. Retrieved from http://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-06yrs.pdf Yost, K. (1993). Childhood immunizations. CQ Researcher, 3, 529-552. Retrieved from http://library.cqpress.com/cqresearcher/