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Disproving the Fear— Autism Linked Vaccinations Christy Donovan, BBA; Rachel House, BSHP; Alysa Walden, BSHP

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Disproving the Fear— Autism Linked Vaccinations Christy Donovan, BBA; Rachel House, BSHP; Alysa Walden, BSHP Disproving the Fear— Autism Linked Vaccinations Christy Donovan, BBA; Rachel House, BSHP; Alysa Walden, BSHP MSN Clinical Nurse Leader Program, College of Nursing Background • 1998- Wakefield’s publication suggested link between autism and MMR vaccine • Wakefield’s findings produced fear of vaccinating children • 2004- Britain's General Medical Council investigation found Wakefield “dishonest and irresponsible” • 82% of parents received advice from media on vaccines (Allan, 2010); (Recame, 2012) • 2008, CDC—98% of those with measles had no prior vaccinations • Survey of 203 parents—“Fear of side effects” number one reason for not vaccinating • 2010- Lancet medical journal fully retracted Wakefield study • Present- 20 higher-quality studies failed to show link between MMR vaccine and autism (Allan, 2010); (Recame, 2012) Purpose • This literature review was performed to answer the question, are children who are immunized as infants compared to children who are not immunized as infants at increased risk of developing autism? Literature Search Strategy • Databases: Medline and CINAHL • Key search terms: Infant through 5 years of age, immunizations OR vaccines, and autistic disorder OR autism • Target population: Infant-5 years • Inclusion/exclusion criteria: Published from 2008 to present, infancy to 5 years of age, and the MMR vaccine • 45 articles found and reviewed, 9 articles used BackgroundResults • Level I* evidence, a systemic review, examined 12 studies of evidence for and against alleged association – No association found between MMR vaccine and autism • Four Level IV* studies concluded no association between autism and vaccination trends nor evidence supporting a causal relationship between the two (See Table 1 for result details) *See Figure I for Evidence Hierarchy (Wilson, 2003) Figure 1. Evidence Hierarchy Level I Systemic Review or Meta-analysis Level II Randomized Control Trial Level III Controlled Trials (not randomized) Level IV Case Control or Cohort Studies Level V Systemic Reviews of Descriptive and Qualitative Studies Level VI Descriptive or Qualitative Study Level VII Opinions of authorities and/or reports of Experts (Melnyk, 2011) Table 1. Summary of Review of Studies Study EH* Design Sample Duration Measures Data Smeeth, IV Matched 1294 autistic January OR of autism OR for association between MMR and L., et al., Case and 4469 1991- disorder in disorder was 0.86 (95% CI, 0.68-1.09) 2004 Control non-autistic Decembe vaccinated Study children r 1998 children versus unvaccinated Madsen, IV Retrospecti 500,000 4 year Analyzed link RR of autism amongst vaccinated K., et al., ve Cohort children study between MMR children, compared to unvaccinated was 2002 Study (440,655 vaccine and autism 0.92 (95 % CI, 0.68 to 1.24) received through RR MMR vacci ne) Taylor, IV Time- 498 autistic Birth Change in Relative incidence compared B., et al., Series children records incidence when with control period 0.94 [95% CI, 0.60- 1999 analyses after MMR vaccine was 1.47] and 1.09 [0.79-1.52] 1979 received and autism diagnosis Kaye, J., IV Time- 305 children Children Annual and age Cumulative incidence for boys ages 2 to del Mar Series with diagnosis specific incidence 5 years rose almost fourfold in 1993 birth Melero- analyses diagnosis records of first recorded cohort compared with the 1988 birth Montes, first between diagnosis cohort. Prevalence of MMR vaccination M., & recorded 1988- analyzing was over 95% Jick, H., during 1999 cumulative Incidence continued to rise when MMR 2001 1988-1999 incidence prevalence remained relatively constant. Note.*See Figure 1; OR = Odds Ratio; RR = Relative Risk; CI = Confidence Interval; See Results for findings summary Recommendations for Practice • Fully inform parents on most recent research results • Provide parents with understandable information on vaccination safety • Educate parents on proven risks and benefits of MMR vaccine • Advantages of Recommendations: – Provides parents with simplistic resources they are unable to obtain themselves (Gardner, 2010); – Eliminates parent’s fears and frustrations (Hilton, 2007) Limitations • Time needed to properly inform parents is limited • Parents unwilling to visit healthcare services cannot be informed • Parents’ distrust of the healthcare system may cause barriers • Overcoming Limitations: – Provide simple informational packets to schools, hospitals, daycares, and nurseries, who, in turn, can distribute this information to the parents Conclusions • Based on the most recent evidence found, there is no association between the MMR vaccination and the risk for developing autism • Education of parents will aid in increasing vaccination rates among children References Allan, G., & Ivers, N. (2010). The autism-vaccine story: fiction and deception?. Canadian Family Physician Médecin De Famille Canadien, 56(10), 1013. Gardner, B., Davies, A., McAteer, J., & Michie, S. (2010). Beliefs underlying UK parents' views towards MMR promotion interventions: a qualitative study. Psychology, Health & Medicine, 15(2), 220-230. Hilton, S., Hunt, K., & Petticrew, M. (2007). MMR: marginalised, misrepresented and rejected? Autism: a focus group study. Archives Of Disease In Childhood, 92(4), 322-327. Kaye, J., del Mar Melero-Montes, M., & Jick, H. (2001). Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis. BMJ (Clinical Research Ed.), 322(7284), 460-463. Madsen, K., Hviid, A., Vestergaard, M., Schendel, D., Wohlfahrt, J., Thorsen, P., & ... Melbye, M. (2002). A population-based study of measles, mumps, and rubella vaccination and autism. The New England Journal Of Medicine, 347(19), 1477-1482. Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare, a guide to best practice. (2 ed., pp. 12). Philadelphia, PA: Wolters Kluwer Health/Lipponcott Williams & Wilkins. Recame, M. A. (2012). The Immunization- Autism Myth Debunked. International Journal Of Childbirth Education, 27(4), 76-78. Smeeth, L., Cook, C., Fombonne, E., Heavey, L., Rodrigues, L., Smith, P., & Hall, A. (2004). MMR vaccination and pervasive developmental disorders: a case-control study. Lancet, 364(9438), 963-969. Taylor, B., Miller, E., Farrington, C., Petropoulos, M., Favot-Mayaud, I., Li, J., & Waight, P. (1999). Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet, 353(9169), 2026-2029. Wilson, K., Mills, E., Ross, C., McGowan, J., & Jadad, A. (2003). Association of autistic spectrum disorder and the measles, mumps, and rubella vaccine: a systematic review of current epidemiological evidence. Archives Of Pediatrics & Adolescent Medicine, 157(7), 628-634. .
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