Autism & Vaccinations

Autism & Vaccinations MarylynnAdamski Stephanie Mansfield Kristen Ziolkowski

PICO • What does the literature reveal about the links between autism spectrum disorder and vaccinations?

Wakefield • In 1998 Dr. Andrew Wakefield released a publication stating that the Measles, Mumps and Rubella (MMR) vaccine had the ability to cause inflammation of the bowels. The inflammation would then make the bowels more permeable and allow peptides to leak. It was hypothesized that these peptides were toxic and could spread to the brain causing developmental disorders including but not limited to autism. Following the release of this information many people began to formulate an opinion about the links between autism and the MMR vaccine.

The Aftermath • After the release of the Wakefield Study, researchers began testing Dr. Wakefield’s hypothesis. Researchers have been unsuccessful in finding a link between the MMR and inflammation of the intestines. With no further evidence supporting this hypothesis several people continue to believe there is a link between vaccinations and developmental disorders. Reasons for this belief include the Wakefield’s study, lack of education pertaining to the matter and because developmental disorders are often diagnosed several months after receiving a vaccination; leading parents to believe the two are connected.

Purpose • The purpose of our presentation is to decipher through the research performed and to determine if there is a link between MMR and autism spectrum disorder. This will assist nurses and healthcare professionals to educate families and help them make the most best decision for their children.

MMR: marginalised, misrepresented and rejected? Autism: afocus group study • The objective of this article was to determine the impact the MMR vs. Autism controversy had on parents of children with autism. Quickly after the controversy arose parents began refusing to vaccinate their children. Some parents expressed that they would prefer to have their child natural develop autism than to acquire it from a vaccination. Researchers of this article found that the best practice would be to examine the views of parents of whom have children with autism. Hilton, S., Hunt, K., & Petticrew, M. (2007, January 20). MMR: marginalised, misrepresented and rejected? Autism: a focus group study. Arch Dis Child. doi:10.1136/‌adc.2006.109686

Method & Results • 38 parents were asked a series of questions regarding their children's vaccination history and severity of autism • Beliefs revealed by this study include • Parents believe they may have contributed to the child's development of autism by having them vaccinated • Parents believe that the child has/had a weakened immune system, causing them to react adversely to the vaccination. • Parents noticed a remarkable difference in the child's behavior, mood or health post-vaccination. • Parents see no link between the two factors and believe that autism is a genetic disorder Hilton, S., Hunt, K., & Petticrew, M. (2007, January 20). MMR: marginalised, misrepresented and rejected? Autism: a focus group study. Arch Dis Child. doi:10.1136/‌adc.2006.109686

Literature • In this qualitative study, the literature examined not parents in general but parents of children with autism. Parents are a vulnerable population but those of children with autism have had mixed feelings about vaccinations since the release of Wakefield’s study in 1996. This study looked at what parents think of vaccinations post-controversy and how they feel. It gave the reader valuable insight into a parents frame of mind. This information could be helpful in the future when educated and treating parents and children.

Integration of Evidence • Healthcare professionals are able to see how this controversy has affected parents decision making and the negative impact it has had on vaccinations • Healthcare professionals should educate parents about risks and benefits of vaccinations and should also be able to use evidence based medicine when deterring parents from this controversy

Evaluation of Article • This qualitative study was well executed. It described to readers how this misconception emerged and later how healthcare workers could rectify the situation. • The layout was easy to read and follow. • In some ways, this article used a meta-analysis to research their hypothesis. The researchers data was collected from the clients response during the question and answer portion and also from a statistical analysis of the subgroup.

MMR and Autism, further evidence against a casual association • This article investigated the claims of the Wakefield study by widening the study group. • Study consisted of 100’s of children, not just 12. • Study showed no correlation between MMR vaccinations and Autism • Of the 357 cases diagnosed with Autism 64 cases did not receive any MMR. 43 cases received only one MMR dose and 62 cases received a second dose Farrington, C. P., Miller, E., & Taylor, B. (2001, March 7). MMR and Autism: further evidence against a causal association. Vaccine, 3632-3635. Retrieved from http://0-www.sciencedirect.com.libcat.ferris.edu/‌science?_ob=MImg&_imagekey=B6TD4-43B8K4F-6-1&_cdi=5188&_user=1536291&_pii=S0264410X01000974&_origin=search&_zone=rslt_list_item&_coverDate=06%2F14%2F2001&_sk=999809972&wchp=dGLzVzz-zSkzS&md5=957d5cd1d905e86

Integration of Evidence • Provides information and research to better equip healthcare professional when educating the public • Has a solid research base to reiterate that there is not a link between the MMR and Autism that has been medically proven • Provides the information to help a patient make a well educated decision regarding their child's health

Evaluation of the Article • This article used qualitative research, because it was very scientific and not based on feelings, but on the results whereas the Parents understanding of vaccinations article was a Quantitative research because it was more focused on understanding how the parents felt and what they understood the vaccination/autism connection to be. Both studies used Descriptive statistics showing the mean. • The research study was broad and had appropriate follow up for each of the participants • The article itself was rather short and abrupt, it could have detailed more of the cases without Autism, rather than focusing on the Autistic cases and how many doses of the MMR they received • The hypothesis and study itself was well articulated and on an easy to read basis making this article convenient to pass on to non health professionals as an educational piece

Parent’s Vaccination Comprehension and Decisions • This article surveyed 30 parents to further understand their perception of vaccinations • Participants were asked open ended questions • Participants were assessed at to their basic knowledge as to how vaccinations worked, and any concerns that they had regarding vaccinations • While parents acknowledged they had heard of adverse reactions coming from the MMR vaccine they stated that this did not deter them from vaccinating their child with the MMR. Downs, J. S., Bruine de Bruin, W., & Fischhoff, B. (2008, February 8). Parents’ vaccination comprehension and decisions. Vaccine, 26, 1595—1607. Retrieved from http://0-www.sciencedirect.com.libcat.ferris.edu/‌science?_ob=MImg&_imagekey=B6TD4-4RSRNJ2-1-9&_cdi=5188&_user=1536291&_pii=S0264410X08000315&_origin=search&_zone=rslt_list_item&_coverDate=03%2F17%2F2008&_sk=999739987&wchp=dGLzVzz-zSkzS&_valck=1&md5=d190f037c7133672aefe24286e3d5b9c&ie=/‌sdarticle.pdf

Parent’s Vaccination Comprehension and Decisions • “These parents were generally favorable toward vaccination. Yet many had limited understanding of how it works, making them potentially vulnerable to misinformation (or disinformation).” • “When asked what source(s) they would consult for more information, 10 parents (33%) said that they would ask their doctor or look for a government source and 21 (70%) said that they would look on the Internet. When asked to explain their choice, 21 (70%) cited convenience and 5 (17%) cited trustworthiness. When asked explicitly whether they would use the Internet to find information, 27 (93%) said yes.” Downs, J. S., Bruine de Bruin, W., & Fischhoff, B. (2008, February 8). Parents’ vaccination comprehension and decisions. Vaccine, 26, 1595—1607. Retrieved from http://0-www.sciencedirect.com.libcat.ferris.edu/‌science?_ob=MImg&_imagekey=B6TD4-4RSRNJ2-1-9&_cdi=5188&_user=1536291&_pii=S0264410X08000315&_origin=search&_zone=rslt_list_item&_coverDate=03%2F17%2F2008&_sk=999739987&wchp=dGLzVzz-zSkzS&_valck=1&md5=d190f037c7133672aefe24286e3d5b9c&ie=/‌sdarticle.pdf

Integration of Evidence • Most eye opening in this article is that the general public are getting their information from the internet rather than a trusted health care provider. This makes it all the more imperative as nurses that we educate our patients regarding the importance of vaccinations as well as the way vaccinations work. We also need to allow time to answer questions, and clarify any misunderstanding that the parents may have developed during their internet searches • More patients are taking an active role in their health care and health related decisions it is because of this very fact that as nurses we must keep abreast of the latest research regarding “hot” topics that our patients may have questions about

Evaluation of the Article • Comprehensive and well thought out, easily read and written at a scholarly level • The research was adequate, and the study questions were formulated so as not to pass on or create intentional or unintentional bias • Unfortunately the sample size was rather small. It would have been interesting to see what parents think on a grander scale

A risk-benefit analysis of vaccinations • This article explains to readers the differences in risks and benefits of vaccinations. It highlights several examples of the types of risks and benefits. This article also goes further in depth to attempt to explain the difference between coincidence and causality. Explaining to readers that it can be difficult to prove or disprove a misconception to the public as by the time the study is performed and research is collected the controversy has already had a negative impact on the publics perception. It is then that researchers not only have to prove their theory but also disprove the publics perception. Heininger, U. (2009, October 5). A risk-benefit analysis of vaccination. Vaccine. Retrieved from www.elsevier.com/‌locate/‌vaccine

Risk Vs. Benefit Risks Benefits • Real Risk- each vaccine is capable of causing adverse effects • Alleged Risk- suspected side effects of vaccines (autism after MMR) • Vaccine Efficacy-% level of risk reduction (answers how many people need to be vaccinated to prevent an undesirable outcome in the population) • Herd Immunity- if the majority of people are vaccinated, those that are not are slightly protected by the inability of the organism to multiple and spread from person to person Heininger, U. (2009, October 5). A risk-benefit analysis of vaccination. Vaccine. Retrieved from www.elsevier.com/‌locate/‌vaccine

Integration of Evidence • A risk-benefit analysis should be performed regularly to maintain the publics confidence in the immunization process. • The benefits of immunizations should be emphasized and misconceptions should be clarified and corrected. • Performing an analysis allows for professionals to work as a multidisciplinary team to seek the best patient outcome by keeping information relevant and as up to date as possible.

Evaluation of Article • This article would be useful to healthcare professionals and parents. It should be used as an education tool, assisting parents to have a better understanding of the risk and benefits of immunizations. • The article is designed as a information source. It doesn’t involve a study. It is helpful for anyone working in the health field that may be discussing immunizations with parents.

Conclusion • In conclusion, after reading several articles we have found no direct correlation between vaccinations and autism spectrum disorder. What we have found is that despite all the evidence that disproves this claim, many parents still want to believe there is a link. Our research has helped us learn how to communicate with these parents and given insight into what their thoughts are. The research has also enabled nurses with the tools and evidence they need to disprove these claims.

References • Downs, J. S., Bruine de Bruin, W., & Fischhoff, B. (2008, February 8). Parents’ vaccination comprehension and decisions. Vaccine, 26, 1595—1607. Retrieved from http://0-www.sciencedirect.com.libcat.ferris.edu/‌science?_ob=MImg&_imagekey=B6TD4-4RSRNJ2-1-9&_cdi=5188&_user=1536291&_pii=S0264410X08000315&_origin=search&_zone=rslt_list_item&_coverDate=03%2F17%2F2008&_sk=999739987&wchp=dGLzVzz-zSkzS&_valck=1&md5=d190f037c7133672aefe24286e3d5b9c&ie=/‌sdarticle.pdf • Farrington, C. P., Miller, E., & Taylor, B. (2001, March 7). MMR and Autism: further evidence against a causal association. Vaccine, 3632-3635. Retrieved from http://0-www.sciencedirect.com.libcat.ferris.edu/‌science?_ob=MImg&_imagekey=B6TD4-43B8K4F-6-1&_cdi=5188&_user=1536291&_pii=S0264410X01000974&_origin=search&_zone=rslt_list_item&_coverDate=06%2F14%2F2001&_sk=999809972&wchp=dGLzVzz-zSkzS&md5=957d5cd1d905e86 • Heininger, U. (2009, October 5). A risk-benefit analysis of vaccination. Vaccine. Retrieved from www.elsevier.com/‌locate/‌vaccine • Hilton, S., Hunt, K., & Petticrew, M. (2007, January 20). MMR: marginalised, misrepresented and rejected? Autism: a focus group study. Arch Dis Child. doi:10.1136/‌adc.2006.109686

Autism & Vaccinations