From
Pediatric News

Physicians Grow Frustrated With Vaccine Scares

Bruce Jancin, Denver Bureau

[Pediatric News 33(9):9, 1999. © 1999 International Medical News Group.]

DALLAS -- Many physicians feel mounting frustration at having to spend more and more time responding to parental queries triggered by irresponsible media reports on vaccine side effects, Dr. Natalie J. Smith said at a national immunization conference sponsored by the Centers for Disease Control and Prevention.

That's the message she's hearing loud and clear from vaccine providers in her capacity as chief of the immunization branch of the California Department of Health.

And the Internet is only compounding the problem for physicians. Take, for example, a recent series of articles published in Silicon Valley's San Jose Mercury News -- including its online edition -- which reported on British studies suggesting the measles-mumps-rubella combination vaccine is associated with development of autism and inflammatory bowel disease.

Never mind that expert groups, including the British Medical Research Council, have reviewed the evidence and dismissed the possibility of a link (see accompanying story); once those pieces were published, parental alarm spread through the state and beyond at lightning speed.

"We've heard from health care providers that, as a direct result of these articles, many parents are calling in to ask that their children not receive combined [measles-mumps-rubella] but instead receive each antigen individually at different times," Dr. Smith said.

Earlier this year, the San Bernardino, Calif., coroner's Web site mentioned that a local 13-year-old girl had suddenly died a few days after receiving a dose of hepatitis B vaccine. The press trumpeted a possible connection -- until an autopsy showed she died of appendicitis. By then, however, new suspicions about the vaccine had been raised in many people's minds.

California law allows personal belief exemptions from school immunization requirements, with no distinction made between religious and philosophical objections.

"The good news is that despite increasing negative media stories over past years, the overall personal belief exemption rate in California has stayed steady, with about 0.5% of incoming kindergartners claiming exemptions. The bad news is that exemptions tend to cluster in some schools and counties," the family physician said.

Indeed, in 2.7% of schools in the state, at least 10% of kindergartners sitting in class have immunization exemptions. These children, who obviously are prone to outbreaks of vaccine-preventable diseases, tend to cluster along the coast and in the Sierra in areas where alternative medicine is most widely practiced.

What can concerned physicians and public health officials do? Make sure vaccine information statements are up to date, learn to better address the concerns of parents in high-exemption areas, and work hard at getting some good public relations.

"We need to get out personal stories about the devastation vaccine-preventable diseases can cause," Dr. Smith asserted.

Part of the problem is that the nation's vaccination effort has been so effective that the public encounters vaccine-preventable diseases less often than alleged vaccine side effects, said Dr. Robert T. Chen, chief of the vaccine safety branch at the CDC. He noted that in 1998 there were 7,411 reported cases of vaccine-preventable diseases in the United States and 10,236 cases of vaccine adverse events, causal or coincidental.

Dr. Smith has high hopes for the Vaccine Initiative, a joint project of the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society, which is gearing up to use highly credible sources to put forth to the public and policy makers an independent source of scientifically valid information about immunization.

The Vaccine Initiative is funded by the Robert Wood Johnson Foundation with no government or industry support. Dr. Bruce Gellin of Vanderbilt University in Nashville, Tenn., who directs the project, said the group is getting close to taking to the airwaves after conducting extensive national surveys to help craft its message. The group also plans to develop materials to help physicians answer common patient questions on vaccination, whether about legitimate concerns or misinterpreted data.