Академический Документы
Профессиональный Документы
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Copyright 2010
The issue
All pediatricians and public health authorities recommend a series of immunizations for all children Some parents refuse immunizations for their children or want to alter the recommended schedule How should pediatricians respond to vaccine hesitancy or refusal?
Results
11.5% of parents had refused at least one recommended vaccine Of those whod refused at least one:
56% HPV 32% varicella 32% meningococcal conjugate 18% MMR
Will multiple vaccinations, especially in one visit, impair a babys immune system?
The number of vaccinations over the last century has steadily increased
But the total number of proteins and polysaccharides in the vaccines has diminished dramatically
Bottom line
Kids today get more vaccines but fewer antigens to challenge their immune system Their immune systems can handle it
Danish study
Retrospective follow-up study All 537,303 children born, 1991-98 440,655 (82%) had received MMR
316 children diagnosed with autism 422 children diagnosed with autism spectrum disorders
No association between the age at the time of vaccination, the time since vaccination, or the date of vaccination and the development of autistic disorder.
IOM review
No epidemiological evidence for association or MMR and autism No plausible biologic model No animal model
Hopkins RS, et al. Centers for Disease Control and Prevention. Summary of notifiable diseases-United States 2003. MMWR 2005;52:55.
Outbreak in Arkansas
Sept, 2006 97% of students had been vaccinated 39% had received two doses Allowed comparison of 1 versus 2 doses
Outbreak in Arkansas
Of the 85 children who got varicella
53 had received one dose of vaccine 25 had received two doses 6 had no vaccine but prior varicella disease
Vaccine efficacy:
- 85.4% among those with one dose - 89.1% among those with two doses
Two doses better, but not 100% effective. Natural immunity is not 100% effective, either.
Resources
Chaves SS, Gargiullo P, Zhang JX, Civen R, Guris D, Mascola L, Seward JF. Loss of vaccineinduced immunity to varicella over time. N Engl J Med. 2007 Mar 15;356(11):1121-9. Diekema DS. Choices should have consequences: failure to vaccinate, harm to others, civil liability. Michigan Law Review. Diekema DS and AAP Committee on Bioethics. Responding to parental refusals of immunization of children. Pediatrics. 2005 May;115(5):1428-1431 .
Freed GL, Clark SJ, Butchart AT, Singer DC, Davis MM. Parental vaccine safety concerns in 2009.
Pediatrics. 2010 April;125(4): 654-9.Epub 2010 Mar 1. Gross L. A broken trust: lessons from the vaccine-autism wars. PLoS Biol. 2009 May;7(5):1-7.
Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, Thorsen P, Olsen J, Melbye M. A
Population-Based Study of Measles, Mumps and Rubella Vaccine and Autism. N Engl J Med. 2002 Nov 7;347(19):1477-82
Offit PA, Quarles J, Gerber MA, Hackett CJ, Marcuse EK, Kollman TR, Gellin BF, Landry S. Addressing
parents concerns: do multiple vaccines overwhelm or weaken the infants immune system? Pediatrics. 2002 Jan;109(1):124-29.