Vaccinations- Helping Patients Separate Facts from Fiction

Dr. Rajiv Naik, MD, FAAP, has been recognized by both the American Academy of Pediatrics and the Centers for Disease Control and Prevention for his work on improving vaccination rates at Gunderson Health System® (GHS).

Dr. Naik’s efforts have yielded impressive results. At GHS, the HPV immunization rate for females (before the age of 13 years) rose from 41 percent (2015) to 66 percent (2018). The national immunization rate is 36 percent.

Similarly, HPV immunization rate for males (before the age of 13 years) rose from 31 percent (2015) to 60 percent (2018). The national immunization rate is 31 percent.

This article highlights Dr. Naik’s work to improve vaccination rates. We’ll explore common misconceptions related to vaccinations and offer providers quick answers to –

• help debunk some of the most common vaccination myths,
• identify barriers to vaccinations, and
• provide tips to increase vaccination rates among the patient population.

Dr. Naik utilizes the CASE (Collaborate-About Me-Science-Explain/Advise) technique when patients approach him with questions or concerns about common vaccination myths. This technique addresses the patient’s concerns from a non-confrontational, team-based care perspective. The team works the patient, offering information that helps them make the best decision for their health.

The following Myth / Fact format addresses some of the scientific information to provide to patients during the Science portion of the discussion with the patient.

Myth: Vaccines cause autism. (MMR and autism)

Fact: No basis in science . . . but the myth began with FAKE science.

In 1998 Andrew Wakefield, an English physician, published a report (not a controlled study) about children with gastrointestinal problems, eight of whom were diagnosed with autism within several weeks after receipt of MMR vaccine.

• Wakefield expressed the opinion that giving measles, mumps, and rubella together in a vaccine might lead to a leaky gut causing proteins and live virus to enter the bloodstream, flow to the brain and cause autism. This theory was not part of the published report.
• After the report was published, it was found that Wakefield falsified information, used faulty science, and took large sums of money from trial lawyers trying to prove a link between autism and the MMR vaccine.
• Subsequently, the Wakefield paper was retracted and Dr. Wakefield’s medical license was revoked.
• It is true that autism diagnoses are increasing. This is due to:
  • greater awareness
  • universal screening
  • reclassification of the disorder which is much more inclusive
  • later parental age (especially of the father).
• Autism is frequently diagnosed between one and four years of age, during the time that children receive the most vaccines. However, the coinciding timeframe does not support a causal relationship between the two.
• Multiple studies all over the world involving hundreds of thousands of children have all shown NO link between MMR (or any vaccine) and autism.
• Specifically, in a 2015 study of more than 95,000 children, no link was found between having the MMR vaccine and developing autism. Furthermore, there was no link for children with a sibling with autism.¹

Myth:  Vaccines are not safe.

Fact:  Vaccines are studied as much or more than any other medical treatment.

• Our vaccines are different than they used to be. In 1960, we were giving just three vaccines (small pox, polio, DTP). Those vaccines contained more than 3,200 antigens. Today, in the entire series of vaccines, although we are giving more injections and protecting against many more diseases, we are giving 25 times fewer antigens. o Antigens are anything foreign to the immune system.
  • Our immune systems can respond to billions of antigens and responds to many thousands of them in our day-to-day life.
  • In the entire childhood vaccine series, only 130-140 unique antigens are administered. This is “a drop in the bucket” compared to the number of antigens we are exposed to in everyday life, including common infections.
• The number of immunizations we are giving is safe, effective and tested vigorously.

Myth:  Preservatives in vaccines are unsafe (toxic).

Fact:  Most vaccines do not contain preservatives.

• Preservatives were used in some vaccines in the past to prevent contamination. Preservatives have been removed from almost all vaccines because most vaccines are packaged as single dose vials now and do not require preservatives. Additionally, when preservatives were used, they were NOT shown to be toxic.
  • For example, Thimerosal was a common preservative used in some vaccines before 2001. Thimerosal has never been shown to have any toxic effects in studies involving hundreds of thousands of patients, but was removed from almost all vaccines anyway. The only current vaccine that may contain Thimerosal is influenza (flu). It is only present in the multi-dose vial.
• Aluminum
  Some vaccines contain aluminum to help with the immune response. Aluminum comes from the earth’s crust, and we ingest aluminum on a daily basis in many household products including food, medicine, cosmetics, antiperspirants, etc.
• The amount of aluminum in vaccines is very small. Adults typically ingest 7 to 9 milligrams of aluminum per day. For comparison, the aluminum contained in all vaccines is similar to that found in about 1 quart (32 fluid ounces) of infant formula.

Myth:  It’s better to become immune by getting the infection naturally.

Fact:  In some cases, natural immunity may be better, but going through the disease process presents serious risks.

• In some but not all cases, natural immunity lasts longer than immunity from vaccines. However, natural infection is associated with many risks and costs including: death, hospitalizations, severe disability including brain damage, hearing loss, birth defects, loss of limbs, sterility, etc.
• The risks of vaccines are very small and the risk of a severe injury from a vaccine is very rare. A person is more likely to be struck by lightning or die while bathing than to experience a vaccine injury.

Other important benefits

Vaccines are very cost-effective. A 2009 economic analysis found that each dollar invested in vaccines and administration, on average, resulted in $3 in direct benefits and $10 in benefits when societal costs are included.

• The benefits of vaccines are profound:
  • A report published in 2013 found that over the past decade, vaccines prevented 26 million illnesses in the U.S.
  • A report published in 2007 found that vaccines prevent one to two million illnesses every year

1. JamaNetwork.com, “Autism Occurrence by MMR Vaccine Status Among U.S. Children with Older Sibling with and without Autism,” (accessed December 17, 2018), available at JamaNetwork.com.

2. CDC.gov, “Chickenpox Vaccine Saves Lives and Prevents Serious Illness”, (accessed December 18, 2018), available at cdc.gov.

3. CDC.gov, “What are the benefits of flu vaccination”, (accessed December 18, 2018), available at cdc.gov.