Editorial
Link Between Vaccines and Childhood Illnesses

Niranjan Kissoon, M.D., Editor

Many of you are aware of the recent concerns raised about a causal link between the measles, mumps and rubella (MMR) vaccination and autism. This was initially suggested by a report in The Lancet and subsequently fueled by sensational newspaper headlines and television programs. The authors advise that parents should only allow their child to have single vaccine antigens, each separated by at least one year. This would pose a bureaucratic nightmare and would be difficult to administer these vaccines within the time in which they would be most affective. Concerns of adverse effects have been voiced since the discovery of vaccines and now threaten to jeopardize widespread immunization programs. The issue of MMR and autism therefore is the tip of the iceberg.

It is well recognized that the present vaccines are safe and efficacious. In fact, the issue of any causal link between MMR and autism should be laid to rest by the recent Institute of Medicine Report, which found no evidence to substantiate this claim. Healthcare providers should therefore not see safety concerns as an issue; however, this is not always the case. Many conditions with early onset in childhood such as autism, convulsions and asthma first declare themselves at the time when immunizations are administered. These temporal relationships have raised the issue of cause and effect. However, an attempt to make a causal link is fraught with many pitfalls. Teleology, when taken to extremes, can lead to harmful decisions at its worst and bad humor at its best. For instance, every human being dies sometimes after their last meal; this temporal relationship may lead us to believe that all human beings die because of food poisoning. While this extreme example is meant facetiously, one gets the point.

Nowadays, parental objection to immunization stem from a variety of reasons including risks of harm. Moreover, the success of immunization programs have left them with little experience of the diseases prevented by immunization. They perceive these diseases as not serious, are uncommon and vaccination may be ineffective or unsafe. Therefore, in some minds, the risks of immunizations outweigh their benefits. However, parental concerns can be alleviated if healthcare professionals provide accurate information to enable parents to make informed decisions about their child's vaccination. Furthermore, healthcare providers approach to vaccination may be guided by their personal preferences and at times, misinformation. It would seem therefore, that the success of immunization programs will lie in the education of healthcare professionals.

Professionals must be educated at two levels. They must be given the appropriate information pertaining to the risk and benefits of immunization and they must be taught to convey this information in a manner that is tailored to the education level and concerns of parents. Our acquisition of this knowledge and endorsement of full compliance with the present recommendations for vaccinations should go a long way in dispelling myths and skepticism within our circle of influence. The benefits of vaccination clearly outweigh the risk.

June/July, 2001/ Jacksonville Medicine

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