Helping Patients Separate Facts from Fiction
Vaccinations have been in the national spotlight for the last few years, leading to lots of misinformation and confusion.
As a result, patients may ask their providers for more information about vaccinations or be resistant to receiving vaccinations based on false information.
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
- 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.
- Vaccines are studied in thousands of people before approved for routine use and then are followed in post-approval studies in tens of thousands subjects.
- A national database tracks any concerns about any vaccine. The Vaccine Adverse Event Reporting System (VAERS) identifies rare problems with vaccines.
- The combination of multiple and large studies, as well as tracking systems involving millions of people provides valuable data on the relationship of vaccines to 200 categories of illness, death, emergency room visits or hospitalizations. Potential safety concerns are identified and if the concerns are scientifically demonstrated, recommendations are promptly updated. These systems ensure that vaccines meet or exceed the same standards of safety as other medical treatments.
Myth: This vaccine is too new.
Fact: Vaccines undergo at least three sets of rigorous studies.
- By the time a vaccine is recommended for use, extensive scientific data and clinical experience have been analyzed to support licensure for use.
- Three sets of rigorous studies are required for licensure:
- Phase I: Researchers test a new drug or treatment in a small group of people to evaluate its safety, determine a safe dosage range, and identify side effects.
- Phase II: The drug or treatment is given to a larger group of people to test its effectiveness and to further evaluate its safety.
- Phase III: The drug or treatment is given to large groups of people to confirm its effectiveness, monitor side effects, compare it to commonly used treatments and collect information that offers the best way for the drug or treatment to be used safely.
- After licensure, two types of ongoing surveillance continue -
- Active surveillance (controlled and studied prospectively)
- Passive surveillance (anybody can report anything) finds any unexpected or rare problems associated with the vaccines.
Myth: We are giving too many shots (immune overload theory).
Fact: Fewer antigens are being administered now than in the past.
- 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.
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
Top 11 Interventions to Increase Vaccination Rates
The following are suggested interventions provided by Dr. Naik for how to best begin to improve patient vaccination rates at your practice site.
- Requiring vaccination records at initial appointment.
- Reviewing vaccination status at all visits.
- When giving the first shot in a series, schedule appointments for future shots.
- Vaccinating at acute visits.
- Integrating registry into daily workflow.
- Implementing a recall system.
- Implementing standing orders for routing and ‘shot only’ visits.
- Utilizing non-confrontational communication with parents.
- Clinician and staff training on vaccine office systems and communication strategies.
- Ensuring accurate patient lists.
- Using data and rapid cycle testing to continuously improve (Plan-Do-Study-Act Cycle).
- Each year, the chickenpox vaccine prevents an estimated 3.5 million cases in the United States and is nearly 100 percent effective at preventing severe cases.2
- In 2016-2017, flu vaccines prevented an estimated 5.3 million flu illnesses, 2.6 million flu-related medical visits and 85,000 flu-related hospitalizations.3
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.