Vaccines and Vaccinations

Research Methods for Health ServicesJulie DeSalva

Prof. Theresa ReboliSeptember 8th, 2015

How Do Vaccines Work? - Immunity Vaccines work by building

the body's immunity. Immunity is the body's

method of preventing disease and is the function of the immune system.

The immune system prevents disease by identifying germs as invaders by their antigens, and produces antibodies in response, which fight off the germs.

The first time the immune system encounters a germ, antibodies will be produced, but they will not be produced before the person becomes ill.

However, the immune system will "remember" this germ and its specific antigens.

If the same germ invades the body again, the immune system will react quickly and destroy it before any illness can result ("Childhood Vaccines," 2015)

How Do Vaccines Work With Immunity?

Vaccines cause immunity to be built without a person having to be sick in the first place. Vaccines introduce a germ's

antigens to the body, but in a killed or weakened form, so the germ can't make a person sick, but its antigens stay strong enough to trigger the production of antibodies and the building of immunity.

By building immunity this way, vaccines prevent diseases from causing suffering and even death. This is especially important

for some people who cannot be vaccinated, because they are too young or their health isn't strong enough. Others being vaccinated keeps them safe. ("Childhood Vaccines,"

2015)

History of Vaccines and Vaccinations Late 1700s - Mid 1800s

1796 - Dr. Edward Jenner developed the first vaccine in England. The vaccine was developed for immunity to smallpox by using cowpox instead. While revolutionary for his time, Jenner's discovery was criticized as being

"unchristian," unsanitary, and a violation of personal freedom. 1853 - Britain enacted the Vaccination Act of 1853, which requires

children from infancy to 3 mos. to be vaccinated 1867 - Britain enacted the Act of 1867, which extended required age to 14

years old and added penalties for refusal to be vaccinated or to vaccinate. These acts only added fuel to the fire that vaccination violated personal

liberty. The Anti Vaccination League and Anti-Compulsory Vaccination League were

formed in response. ("Opposition Has Existed as Long as Vaccination Itself," 2015)

History of Vaccines and Vaccinations Mid 1800s - Late 1800s

Other demonstrations of public criticism and opposition to vaccines led to several changes, including the creation of a commission to study vaccines, the removal of the penalties for failure to vaccinate, and the inclusion of a "conscientious objector" clause, which allowed parents who mistrusted vaccines to obtain an exemption certificate.

Late 1800s - Outbreaks of smallpox in the U.S. led to vaccination campaigns and anti-vaccination activities, including the creation of the Anti Vaccination Society of America in 1879, the New England Anti Compulsory Vaccination League in 1882, and the Anti-Vaccination League of New York City in 1885. Opponents to vaccination waged court battles to repeal vaccination

laws in many states, including Illinois, California, and Wisconsin. (Opposition Has Existed as Long as Vaccination Itself," 2015)

History of Vaccines and Vaccinations Early 1900s - Mid 1900s 1902 - The Cambridge, MA Board of Health issued a demand that all city

residents be vaccinated against smallpox, following an outbreak. One resident, Henry Jacobson, refused, and the city filed criminal charges against him. Jacobson lost his case locally and appealed to the U.S. Supreme Court. The Supreme Court ruled in favor of the state in 1905, saying that the state

could enact mandatory laws to protect its population in the event of an infectious disease.

This was a landmark case, as it was the first U.S. Supreme Court case on the power of states in the realm of public health.

1915 - Similar justification to Jacobson v. Massachusetts was used when New York City officials forcibly quarantined cook Mary Mallon ("Typhoid Mary") after many of her patrons died of typhoid fever and she refused to change her occupation. She was exiled to an island in the East River, where she remained the rest of her life.

("Opposition Has Existed as Long as Vaccination Itself," 2015)

History of Vaccines and Vaccinations Mid 1900s to Late 1900s 1950s - 1960s - More vaccines were created to prevent infectious

diseases: Polio in the 1950s, and measles, mumps, and rubella in the 1960s

1980 - Using justifications from Jacobson v. Massachusetts, all 50 states had enacted laws demanding mandatory vaccination of schoolchildren for vaccine-preventable diseases, with the only exceptions made for medical or specific non-medical reasons, like religious beliefs, although these were rarely used. Compliance was easily sought, as the vaccines worked, with new

infections of polio in the U.S. disappearing, the global eradication of smallpox, and measles infections going from 500,000+ American children in 1962 (with 48,000 hospitalizations and 450 deaths), to an annual number of measles infections dropping to >100 in 1997.

(Oshinsky, 2015)

History of Vaccines and Vaccinations The DTP Controversy Mid 1970s - A report from the Great Ormond Street Hospital for Sick

Children in London alleged that neurological disorders had resulted from Diphtheria, Tetanus, and Pertussis (DTP) vaccinations in 36 children. This resulted in an international controversy, allowing the anti-vaccination

movement to gain ground once more. A decrease in vaccination rates and 3 major epidemics of pertussis ("whooping cough") resulted from this controversy in the U.K.

The U.K. launched a study of every child between the age of 2 mos. and 36 mos. who had been hospitalized for neurological illness in the U.K., to understand whether the vaccine was associated with an increased risk of neurological illness. The results found a very low risk of neurological illness with vaccination.

Increased media attention to alleged risks of the DTP vaccine caused controversy in the U.S.

("Opposition Has Existed as Long as Vaccination Itself," 2015)

History of Vaccines and Vaccination The Wakefield Report and the MMR Controversy - 1 1998 - Dr. Andrew Wakefield published a report in the Lancet that

alleged a connection between bowel disease, autism, and the measles, mumps, and rubella (MMR) vaccine. The allegations were seized upon by the media, sparking public alarm

and upheaval over the safety of the MMR vaccine. 2004 - The Lancet said it should not have published Wakefield's

work. The General Medical Council, an independent regulator for doctors

in the U.K., found Wakefield guilty of conflict of interest, as he had been paid by a law firm to find evidence to support the litigation case of parents who believed their children had been harmed by vaccination.

("Opposition Has Existed as Long as Vaccination Itself," 2015)

History of Vaccines and Vaccination The Wakefield Report and the MMR Controversy - 2

2010 - The General Medical Council struck Wakefield from the medical register in Great Britain and forbade him from practicing medicine there. The Lancet formally retracted Wakefield's report following this.

A series of reports by journalist Brian Deer found evidence that Wakefield had falsified data, a form of scientific fraud, and that Wakefield had hoped to receive financial gain from his investigations.

As a result of the Wakefield report, multiple research studies have been conducted to determine the safety of the MMR vaccine. None of these studies found a connection between the MMR vaccine and

autism. ("Opposition Has Existed as Long as Vaccination Itself," 2015)

History of Vaccines and Vaccinations The Thimerosal Controversy 1990s - Debate arose over thimerosal, a mercury compound used as

a preservative for vaccines, and whether it was linked to autism. 1999 - Leading American public health and medical organizations

and vaccine manufacturers agreed that the use of thimerosal should be reduced or eliminated.

2001 - The Institute of Medicine's Immunization Safety Review Committee published a report that stated that there was neither enough evidence to prove nor to disprove the claim that thimerosal in childhood vaccines caused attention deficit hyperactivity disorder, speech or language delays, or autism. A more recent report from the committee favored rejection of the theory

that thimerosal-containing vaccines cause autism. ("Opposition Has Existed as Long as Vaccination Itself," 2015).

Vaccines and Vaccinations - Present Claims of links between vaccines and various conditions,

whether proven or disproven, have had a very negative effect on vaccination rates, with vaccination rates below the level necessary to contain an infectious disease in some areas. Most outbreaks are occurring in areas where exemptions are the

easiest to obtain and where unvaccinated children converge. The situation is not improving: as of this year, 2015, an

outbreak of measles in the U.S. already had 140+ cases by February. This most recent outbreak has only added more fuel to an already vigorous fire.

(Oshinsky, 2015)

Who Needs Vaccines and Why? - 1 Infants and Toddlers: Vulnerable due to being very young and not having been

exposed to certain germs and their antigens yet. They need to be immunized for their safety.

Children between the ages of 2 and 10: Vulnerable due to being young and possibly not exposed to certain germs and their antigens. They need to be immunized for their safety.

Preteens and Teens: Vulnerable to exposure from being immature and beginning to engage in activities that can easily spread disease, like kissing and sexual activity. They need to be immunized for their safety.

College Students: Vulnerable to exposure to germs from close contact, kissing, and sexual activity. They need to be immunized for their safety.

Young Adults: Vulnerable to exposure to germs from close contact, kissing, and sexual activity. They need to be immunized for their safety.

Parents: Responsible for the health of vulnerable children, and they need info about vaccination so that their children receive appropriate vaccines on time. They need to plan their own vaccinations to keep their children safe.

("Specific Groups of People," 2015)

Who Needs Vaccines and Why? - 2 Pregnant Women: Responsible for the health of vulnerable children, and they

need info about vaccination so that their children receive appropriate vaccines on time. Also, some infectious diseases can pass from mother to child during pregnancy, childbirth, and breastfeeding. They need to plan their own vaccinations prior to pregnancy, if possible, to keep their children safe.

Health Care Workers: Vulnerable to exposure to germs and their antigens due to contact with patients with many different diseases and conditions. Responsible for the health of their vulnerable patients. They may unknowingly transmit infectious diseases if they are not properly vaccinated and become infected. They should be immunized for their own and their patients’ sakes.

Health Care Professionals: Vulnerable to exposure to germs and their antigens due to contact with patients with many different diseases and conditions. Responsible for the health of their vulnerable patients. They may unknowingly transmit infectious diseases if they are not properly vaccinated and become infected. They should be immunized for their own and their patients’ sakes.

("Specific Groups of People," 2015)

Who Needs Vaccines and Why? - 3 Health Program Managers: Responsible for ensuring the health of

populations. May be vulnerable to exposure to germs and their antigens due to contact with health care workers and health care professionals who are easily exposed to diseases. They should be immunized for their own, their workers, and their populations’ sakes.

Child-Friendly Locations: Responsible for providing safe areas. Vulnerable to becoming a hotspot for transmission of germs, as they are places where many children can gather and easily spread disease. Their workers should be immunized for their clients’ sakes.

People With Certain Health Conditions: Vulnerable to exposure to germs and their antigens due to their health conditions (such as diabetes, heart disease, lung disease, renal disease, or HIV/AIDS infection). They need to be immunized for their safety.

People from Certain Racial and Ethnic Groups: Vulnerable to exposure to germs and their antigens due to disparities in vaccination rates across racial and ethnic groups, often due to poor access to health resources, provider biases, poor health literacy, etc. They need to be immunized for their safety.

("Specific Groups of People," 2015)

Who Needs Vaccines and Why? - 4 Travelers: Vulnerable to exposure to germs and their antigens due to disparities in

vaccination rates in other countries, often due to their populations having poor access to health resources and poor health literacy. They need to be immunized for their safety.

Refugees: Vulnerable to exposure to germs and their antigens due to disparities in vaccination rates in other countries, often due to their populations having poor access to health resources and poor health literacy. They need to be immunized for their safety.

Immigrants: Vulnerable to exposure to germs and their antigens due to disparities in vaccination rates in other countries, often due to their populations having poor access to health resources and poor health literacy. They need to be immunized for their safety.

Families Adopting International Children: Vulnerable to exposure to germs and their antigens due to disparities in vaccination rates in other countries, often due to their populations having poor access to health resources and poor health literacy. They need to be immunized for their own and their adopted children’s safety.

(“Specific Groups of People,” 2015)

Who Should NOT Receive Some or All Vaccines? Some people should not receive vaccines or certain vaccines in

particular. These people include: Those with severe, life-threatening allergies to components in some

vaccines. Those who have ever had Guillain Barré Syndrome. Those who have suffered adverse effects from previous vaccinations. Those with long-term heart, kidney, breathing, liver, or nervous system

issues. Those in treatment for cancer. Those with HIV/AIDS. Those being treated with drugs (such as steroids) that affect the immune

system. Sometimes, women who are pregnant or breastfeeding.

("Who Should NOT Get Vaccinated?," 2015)

Reasons For And Against Receiving VaccinesReasons for Receiving Vaccines Vaccination has had great success

with reducing and eliminating infectious diseases, like diphtheria, pertussis, measles, mumps, and rubella, which used to strike hundreds of thousands of people annually in the U.S. during the 1800s and early 1900s.

Vaccination also benefits those who cannot be vaccinated by maintaining a high level of herd immunity. (National Institute of Allergy and

Infectious Diseases, 2014)

Reasons Against Receiving Vaccines

The public no longer has a strong base of trust in vaccines and vaccinations, especially parents who may be confused and concerned while trying to protect their children from harm.

(Kennedy et al., 2011, p. 1152) People dislike having the

government intrude into their freedom to choose what they do with their bodies or their families' bodies (i.e. their bodily autonomy).

(Kluck, 2010)

Vaccines Available in the U.S.

Varicella (Chickenpox) Diphtheria Hib Hepatitis A Hepatitis B Seasonal influenza (Seasonal Flu) Measles Mumps Rubella Tetanus Pertussis (Whooping Cough) Japanese Encephalitis (JE)

HPV Meningococcal Pneumococcal Rabies Rotavirus Polio Herpes Zoster (Shingles) Tuberculosis (TB) Yellow Fever Typhoid Anthrax Smallpox

There are vaccines available in many combinations and forms for the following diseases:

("List of Vaccines Used in the U.S.," 2015)

Solutions for Dropping Vaccination Rates Efforts should be focused in three areas:

Implementation of a thorough research program into the motivations of the American populace that opposes or is uncertain of present vaccination policies, and into the trends of vaccination acceptance.

Testing of new methods for the reduction of childhood vaccination opt-outs while retaining parents' freedom to make health decisions for their children

Organization of a well-funded effort into effective communication with and active listening to concerned and confused parents.

(Winsten & Serazin, 2013, A.15)

Future for Vaccines New or better vaccines could be available to the public for the

prevention of HIV/AIDS, malaria, and tuberculosis within the next two decades. This is important, as there is no vaccine for HIV/AIDS or malaria,

and tuberculosis is incredibly hard to prevent and treat. There could be vaccines for the treatment of autoimmune

disorders (like insulin-dependent diabetes and celiac disease) and cancer within the next twenty to fifty years.

(Nossal, 2011)

Works Cited - 1 Centers for Disease Control and Prevention. (2015, September 3). Vaccines and

immunizations: List of vaccines used in the United States. Retrieved from http://www.cdc.gov/vaccines/vpd-vac/vaccines-list.htm

Centers for Disease Control and Prevention. (2015, August 17). Vaccines and immunizations: Who should not get vaccinated with these vaccines? Retrieved from http://www.cdc.gov/vaccines/vpd-vac/should-not-vacc.htm

Centers for Disease Control and Prevention. (2015, July 6). Vaccines and immunizations: For specific groups of people. Retrieved from http://www.cdc.gov/vaccines/spec-grps/default.htm

Centers for Disease Control and Prevention. (2014, May 19). Vaccines and immunizations: Why are childhood vaccines so important? Retrieved from http://www.cdc.gov/vaccines/vac-gen/howvpd.htm

Kennedy, A., LaVail, K., Nowak, G., Basket, M., & Landry, S. (2011). Confidence about vaccines in the united states: Understanding parents' perceptions. Health Affairs, 30(6), 1151-9. Retrieved from http://search.proquest.com/docview/874621010

Works Cited - 2 Kluck, S. (2010). Mandatory Vaccinations Deny Parents Their Rights. In N. Merino (Ed.), At Issue.

Should Vaccinations be Mandatory? Detroit: Greenhaven Press. (Reprinted from Mandatory Vaccines Override Parental Rights, United Liberty, 2008, October 18) Retrieved from http://ic.galegroup.com/ic/ovic/ViewpointsDetailsPage/ViewpointsDetailsWindow?failOverType=&query=&prodId=OVIC&windowstate=normal&contentModules=&display-query=&mode=view&displayGroupName=Viewpoints&limiter=&currPage=&disableHighlighting=true&displayGroups=&sortBy=&search_within_results=&p=OVIC&action=e&catId=&activityType=&scanId=&documentId=GALE%7CEJ3010616206&source=Bookmark&u=berkeleycoll&jsid=48d543880d3191fc28123cce6e3ae1e1

National Institute of Allergy and Infectious Diseases. (2014). Vaccines Prevent Infectious Diseases. In R. Espejo (Ed.), At Issue. Do Infectious Diseases Pose a Threat? Detroit: Greenhaven Press. (Reprinted from Vaccines: Understanding, n.d.) Retrieved from http://ic.galegroup.com/ic/ovic/ViewpointsDetailsPage/ViewpointsDetailsWindow?failOverType=&query=&prodId=OVIC&windowstate=normal&contentModules=&display-query=&mode=view&displayGroupName=Viewpoints&limiter=&currPage=&disableHighlighting=false&displayGroups=&sortBy=&search_within_results=&p=OVIC&action=e&catId=&activityType=&scanId=&documentId=GALE%7CEJ3010315225&source=Bookmark&u=berkeleycoll&jsid=ee9ef598c01b3c671bb0b0a903082c2d

Nossal, G. (2011). Vaccines of the future. Vaccine, 29, D111-D115. doi:http://dx.doi.org/10.1016/j.vaccine.2011.06.089

Works Cited - 3 Omer, S. B. (2011). Vaccination Refusal Endangers Public Health. In D. Haugen & S. Musser (Eds.),

Opposing Viewpoints. Epidemics. Detroit: Greenhaven Press. (Reprinted from New England Journal of Medicine, 2009, May, 1981-1988) Retrieved from http://ic.galegroup.com/ic/ovic/ViewpointsDetailsPage/ViewpointsDetailsWindow?failOverType=&query=&prodId=OVIC&windowstate=normal&contentModules=&display-query=&mode=view&displayGroupName=Viewpoints&limiter=&currPage=&disableHighlighting=false&displayGroups=&sortBy=&search_within_results=&p=OVIC&action=e&catId=&activityType=&scanId=&documentId=GALE%7CEJ3010133277&source=Bookmark&u=berkeleycoll&jsid=98403098015061c98eacba8376c0608d

Opposition to Vaccines Has Existed as Long as Vaccination Itself. (2015). In N. Merino (Ed.), At Issue. Vaccines. Farmington Hills, MI: Greenhaven Press. (Reprinted from History of Anti-Vaccination Movements, 2014) Retrieved from http://ic.galegroup.com/ic/ovic/ViewpointsDetailsPage/ViewpointsDetailsWindow?failOverType=&query=&prodId=OVIC&windowstate=normal&contentModules=&display-query=&mode=view&displayGroupName=Viewpoints&limiter=&currPage=&disableHighlighting=true&displayGroups=&sortBy=&search_within_results=&p=OVIC&action=e&catId=&activityType=&scanId=&documentId=GALE%7CEJ3010938203&source=Bookmark&u=berkeleycoll&jsid=bb854fd8c18e9d089ede278bb5d5848e

Oshinsky, D. (2015, Feb 20). The return of the vaccine wars; the controversy over vaccines is as old as vaccination itself. Wall Street Journal (Online) Retrieved from http://search.proquest.com/docview/1656444670

Winsten, J., & Serazin, E. (2013, Feb 07). Rolling back the war on vaccines. Wall Street Journal Retrieved from http://search.proquest.com/docview/1284579027