Parents are responsible for making decisions that affect their children’s health, one major decision being to immunize or not to immunize. Recent increases in the incidence of autism in addition to accusations that vaccines are linked to the onset of autism, have dissuaded some parents to have their children immunized. These children are left vulnerable to serious diseases such as measles, mumps, and rubella. Until recently most children received vaccines, therefore the number of children being diagnosed with illnesses like whooping cough and measles were minute. Today’s parents have not seen a child that is sick with rubella or polio, but most have seen an autistic child. Parents are more fearful of having an autistic child because autism is much more visible in our society than polio or measles. Nurses are often on the front lines of parent education regarding the risks and benefits of immunizations. This is where nurses can do their part in teaching parents that the most up to date research shows that vaccines do not cause autism.
There are currently vaccinations against 14 different communicable diseases. These are routinely given during infancy and preschool years as scheduled by the Advisory Committee of Immunization Practices, the Centers for Disease Control and Prevention (CDC), and the American Academy of Family Physicians. Children come into contact with hundreds or thousands of antigens each day and those that have been vaccinated already have a built in defense against these serious and potentially deadly diseases. The longer parents procrastinate vaccinating their infants, the longer their infants are left susceptible to preventable diseases that they are routinely exposed to from the moment of birth (Miller & Reynolds, 2009).
It is important for healthcare providers to understand parents’ hesitation and the influences that can cause parents to be misinformed, and attempt to educate them. The media often plays a large role in misguiding the general population. Parents can easily become confused by the inaccurate claims that are made by nonexperts such as celebrities. Members of the media and celebrities often lack scientific data to back their claims (Healy & Pickering, 2011).
Parents may delay immunizing their children because they hear that the age at which a large group of vaccines are given coincides with the typical age of onset of symptoms of autism, usually around 18 months of age (Miller & Reynolds, 2009). Grant (2010) relays autism consists of an array of neurological disorders that according to the National Institutes of Health are characterized by “social impairments, communication difficulties, and restricted, repetitive, and stereotyped patterns of behavior” (¶4). The issue with the association between the timing of immunizations and onset is that psychosocial qualities develop around the age of 18 months. Autism may have been present before the symptoms of impairment became apparent due to the fact that the infant was still too young to display higher level social interactions.
In 1998 an article published by The Lancet and written by Doctor Andrew Wakefield made the accusation that the measles, mumps, and rubella (MMR) vaccine was causing autism. The paper was later withdrawn and Wakefield’s medical registration was revoked after a two and a half year investigation proved the article to be fraudulent. Never-the-less, the article left parents and health professionals feeling confused and skeptical about the safety of the MMR. There has been no proven correlation between the MMR vaccine’s introduction in 1988 and the increase in autism. Nor has the trend of autism diagnoses declined since the article swayed parents away from vaccinations. There has been, however, an increase in the incidence of measles. The drop in MMR vaccine uptake has caused herd immunity to be lost and measles to become endemic in the United Kingdom. Herd immunity is the percentage of the population required to have immunity against contagious disease to decrease the chances of an outbreak. The “prevention paradox” refers to the assumption that if everyone else’s child is vaccinated, then their child also will be safe from contracting the disease. This attitude has undermined the need for herd immunity and threatens to cause a genuine public health crisis (Shan, 2011). Parents need to be made aware of this data.
In 2005 a study was done in Japan by Honda that looked at vaccination and autism rates. It found that despite a decline in MMR vaccinations, there was actually a rise in the rate of autism. Additionally, it found that the incidence of autism was higher in unvaccinated children born after 1992 than in vaccinated children born before 1992 (Shan, 2011). Again, it appears that there is no evidence based on trends that can pinpoint a causal link between vaccination and autism.
There are many vaccination monitoring systems in place in the United States that regulate the safety and efficacy of immunizations. Not only does the government monitor the safety of vaccines, but so do vaccine manufacturers, physicians, and nurses, as well as parents. Parents know their child’s behavior best and can report concerns regarding immunization reactions with their health providers. Nurses and other healthcare providers are required to keep a record of vaccination information which can be used to trace vaccine lot numbers and any adverse affects linked to those lots. The National Childhood Vaccine Injury Act requires healthcare providers to report adverse affects of vaccinations to the Vaccine Adverse Event Reporting System, which is managed by the CDC and the Food and Drug Administration (FDA). Another method of regulation includes mandatory clinical trials for vaccine manufacturers to complete prelicensing vaccine testing. The manufacturers are also required by the National Childhood Vaccine Injury Act to report adverse affects to the Department of Health and Human Services (Miller & Reynolds, 2009).
Extensive research is ongoing in the quest to discover the etiology of autism and to better understand the nature of this malady. The National Institute of Health has spent hundreds of millions of dollars investigating autism and has ultimately dismissed vaccines as the sole source for autism. However, there remains a need to further examine if infants that are genetically predisposed to autism are at higher risk of becoming autistic following certain vaccinations (Grant, 2010).
There has been a trend recently of small outbreaks of vaccine preventable diseases due in large part to the reluctance of parents to immunize their children; a primary reason parents need to be educated on this subject. One example, according to the medical director of the New York City Health Department’s Bureau of Immunization, happened in Brooklyn, New York in 2009 when measles spread rapidly among unvaccinated children. In 2007 there were 43 reports of measles in the United States which increased to 140 in 2008. Over 90 percent of the affected children had not been vaccinated (Grant, 2010). Although cases are on the rise in the U.S., the numbers are relatively low when compared to some other countries where vaccines are not as readily available. Measles is responsible for the deaths of 800,000 children worldwide each year. A handful of infectious diseases, such as small pox, polio, and measles have been virtually eradicated in the U.S. thanks to vaccines; however, even children in the U.S. that are unvaccinated are left vulnerable to the spread of disease from potential exposure to unvaccinated children (Grant, 2010).
The research opposing the link between immunizations and autism is very complex and vast and can be overwhelming for parents. For this reason it is crucial for nurses to have a knowledge base that utilizes evidence based practice to help parents make the most appropriate decision regarding the health of their child. Nurses are often sought after as experts in all areas of health and well-being and can expect to be called upon to give advice relating to vaccinations to not only their patients, but also their friends, family, and others. Sometimes, however, parents feel that their healthcare providers do not have their child’s best interest in mind and for this reason, it is important for nurses to be open, sincere, nonjudgmental, and non-confrontational when providing patient teaching. The nurse should give information that is unambiguous, easily comprehensible, and accurate. Parents will be more easily convinced when confronted with personal stories and visual images of families affected by preventable diseases, such as Pertussis and measles. Parents should be encouraged to weigh the mostly minor and rare adverse affects of vaccinations against the often devastating risks associated with the vaccine preventable diseases. It is the job of a nurse to promote disease prevention measures; immunizations being one of these measures.
Grant, A. (2010). Vaccine phobia becomes a public health threat. Discover, 31(1), 18-19. Retrieved from EBSCOhost.
Healy, C., & Pickering, L. K. (2011). How to communicate with vaccine-hesitant parents. Pediatrics, S127-S133. doi:10 1542/peds.2010-1722S
Miller, L., & Reynolds, J. (2009). Autism and vaccination—The current evidence. Journal for Specialists in Pediatric Nursing, 14(3), 166-172.
Shan, Y. (2011). Strategies to improve vaccination uptake rates. Primary Health Care, 21(2), 16-21. Retrieved from EBSCOhost.