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Rapid Responses: Rapid Responses published:
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Predicting parents' decisions on vaccination
- Chris D McVittie, Niko Tiliopoulos, Judith Gellatly (14 January 2004)
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When reassurance is no longer reassuring: addressing parental concerns on vaccination
- Julie Hepworth (27 January 2004)
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The prevention of vaccine reactions
- C. Alan B. Clemetson, M.D. (15 November 2004)
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Re: The prevention of vaccine reactions
- Michael D Innis (16 November 2004)
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Anti-vaccine?
- Susan K Hamlyn (17 November 2004)
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Chris D McVittie, psychology lecturer Queen Margaret University College, Clerwood Terrace, Edinburgh EH12 8TS, Niko Tiliopoulos, Judith Gellatly
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EDITOR – The screening of Hear the Silence and subsequent Channel 5 debate on 15 December 2003 has prompted much reaction, in this journal and elsewhere, that appears to have done little to advance discussion of the safety of the MMR vaccine. Concerns of many parents have resurfaced 1 2 following the screening, while the weight of medical opinion has criticised both the presentation of the issue within the programme and the terms of the debate that followed.3 4 To a large extent, these positions merely restate the circumstances prevailing prior to the screening, with medical reassurances about safety being commonly expressed against a background where many parents decide against vaccination of their children. To address parental concerns on this issue effectively requires an understanding of the factors that lead parents to decide for and against vaccination. In the hope of advancing debate, we outline here preliminary findings from an ongoing empirical study of the factors that predict parental decisions. Initial findings from this research indicate that both immunising and non-immunising parents perceive the advice provided by the government and health professionals on the one hand, and the findings produced by research on the other, to be entirely distinct sources of information and moreover to be sources of differing importance. While reliance on government and professional advice predicts decisions in favour of vaccination, it is the importance attached to research findings that overwhelmingly predicts parental decisions against vaccination. The strength of these indicators, even at this stage, suggests that they are likely to be confirmed as predictors in a final analysis. Interestingly, parents do not appear to base decisions on the benefits and risks that they believe to be associated with the MMR vaccine: many parents who consider the risks to outweigh the benefits still have their children vaccinated. These preliminary results suggest that simple professional reassurances are unlikely to allay the safety concerns of non-immunising parents: these parents do not perceive such advice as important or helpful in their decisions. Instead, it is parental perceptions of research on this crucial issue,5 by far the strongest predictor of decisions against vaccination, which have to be addressed. 1 Electronic responses. Hear the Silence. bmj.com 2004. bmj.bmjjournals.com/cgi/content/full/327/7428/1411-a#responses (accessed 13 Jan 2004). 2 Electronic responses. Hear the Silence. bmj.com 2004. bmj.bmjjournals.com/cgi/content/full/327/7428/1411#responses (accessed 13 Jan 2004). 3 Elliman D, Bedford H. Hear the Silence. BMJ 2003;327:1411. 4Fitzpatrick M BMJ 2003;327:1411. 5Johnson CA. BMJ 2004;328:51. Competing interests: None declared |
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Julie Hepworth, Associate Professor Psychology Argosy University San Francisco Bay Area
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Editor- Interestingly, McVittie et al. [1], in their study of parental decisions on vaccination clearly point to the complexity underlying public opinion on this issue. Public distrust of vaccines has resurfaced following the screening of Hear the Silence [2] from what has become a background of relatively constant scepticism about mass immunisation programs. Ignoring the concerns of parents will breed more distrust [3], with the exception of the Blair government’s brief funding of research on the possible link between autism and the MMR vaccine, and is detrimental to the advancement of any public health issue and current policy directives. What McVittie et al.’s early research reveal are the decision-making processes of both immunising and non-immunising parents and their relationships with government, health professionals, and research information that is available to parents. The study highlights that risks and benefits are not significant to the decisions of parents to immunize their children. This finding is consistent with broader health-related decision-making research on risks and benefits that argues that other factors, such as personal experience and family history, play a much greater role. Findings of a forthcoming study suggest that many women regardless of perceiving the risks of hormone replacement therapy to outweigh the benefits would continue to use it [4]. Further, McVittie et al.’s reinforces that public perception of research is the strongest factor influencing decisions not to immunise. Clearly, there is growing evidence for greater government communication of research on immunisation to the public. In an era of increasing public literacy reinforced by public health polices aimed at creating the conditions for more educated self-informed patient groups surely it is time to take public concerns about vaccination more seriously with strategies that do not simply reassure but properly engage with parental concerns. Dr Julie Hepworth PhD, CPsychol. (BPS) [1] Electronic responses. McVittie C, Tiliopoulos, N, Gellatly, J. Predicting parents’ decisions on vaccination. BMJ 2004; 328: 51. (accessed 23 Jan 2004) [2] Electronic responses. Hear the Silence. bmj.com 2004. [3] Electronic responses. Johnson CA. BMJ 2004; 328:51 (accessed 23 Jan 2004). [4] Welton M, Hepworth J, Collins N, Ford D, Knott C, Meredith S, Walgrove A, Wilkes H, Vickers M. on behalf of the WISDOM team. (2004). Decision- making about hormone replacement therapy (HRT) by women in England and Scotland. Climacteric, In Press. Competing interests: None declared |
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C. Alan B. Clemetson, M.D., Professor Emeritus, Tulane University School of Medicine c/o 5844 Fontainebleau Drive, New Orleans, Louisiana 70125
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We know that reports of severe reactions following infant vaccinations, though rare, are causing widespread anxiety among the population. Moreover, physicians are discussing the question as to how many days after vaccination an infant death should be considered as attributable to a vaccine (1). A review of the World literature on vitamin C and vaccine reactions in animals has revealed that supplementary vitamin C (ascorbic acid) has a potent and highly significant protective effect (2). Ascorbic acid reduces both the morbidity and the mortality following the injection of all bacterial and viral toxins tested in guinea pigs, and even in rats and mice, which make their own ascorbic acid from simple sugars in the liver. Clearly, even the ascorbic acid-producing animals do not always make enough ascorbic acid for all their needs. The highly protective effect of vitamin C has also been reported in children by Kalokerinos (3) in his studies of aborigines in Australia. One therefore cannot help wondering why the various national centers for disease control have not yet recommended vitamin C to be given before all vaccinations. It would surely be most beneficial, not only in reducing severe vaccine reactions and deaths, but also in reducing or preventing the residual disabilities which can occur following minor cerebral or subdural haemorrhages. We now know that the bleeding of severe vitamin C deficiency (or scurvy) is due to capillary fragility arising from the accumulation of excessive levels of histamine in the blood (4), causing widening and separation of the tight-junctions between the endothelial cells of the capillaries and venules, from which the bleeding arises (5). The histamine accumulation in scurvy is due to the fact that ascorbic acid is essential for the body’s progressive removal of histamine by converting it to hydantoin-5-acetic-acid and on to aspartic acid in vivo (6). Nowadays, with so many vaccines being given simultaneously to infants, one has to consider that the histamine arising from the injection of these foreign proteins and the histamine arising from any childhood infection will be added to the already elevated blood histamine level due to ascorbic acid depletion, so leading to a toxic blood histamine level which can be fatal. Perhaps this severe condition should not be called Infantile Scurvy or Barlow’s Disease, but rather Toxic Histaminaemia or a Barlow’s Disease Variant. No doubt Health Departments will soon conduct studies of plasma ascorbic acid and whole blood histamine levels on soldiers before and at various intervals after single and multiple vaccinations for overseas duty. Such studies will certainly confirm that outwardly normal people with somewhat low ascorbate levels have markedly elevated blood histamine levels, and that their blood histamine concentrations increase even more following vaccinations. A more useful estimation of the time range of vulnerability for each vaccine might then be made. Until then, we can hope 1) That vaccinations will be postponed when an infant is premature or is ailing in any way, even with the common cold. 2) That consideration will be given to reducing the number of vaccines to be given at one time. 3) That 500 mg of vitamin C powder in fruit juice will be given to infants to drink before their vaccinations. (More vitamin C can be given by intramuscular injection, if the infant develops a high-pitched cry, a febrile illness, or has a convulsion.) C.A.B. Clemetson, M.D., Professor Emeritus, Tulane University School of Medicine, New Orleans, Louisiana, Tele: 504-866-1525, Email: megcc2000@yahoo.com References 1) Buttram H. Shaken baby syndrome, or vaccine-induced encephalitis? Med Sentinel 2001; 6:83-89. 2) Clemetson CAB. Vaccinations, inoculations, and ascorbic acid. J Orthomolecular Med 1999; 14:137-142. 3) Kalokerinos A. Medical Pioneer of the 20th Century. Melbourne, Victoria, Australia: Biological Therapies Publishing Pty Ltd; 2000. 4) Clemetson CAB. Histamine and ascorbic acid in human blood. J Nutr 1980; 110:662-668. 5) Clemetson CAB. Is it “shaken baby,” or Barlow’s disease variant? J Amer Phys Surg 2004; 9:78-80. 6) Chatterjee IB, Majumder AK, Nandi BK, Subramanian N. Synthesis and some major functions of vitamin C in animals. Ann NY Acad Sci 1975; 258:24 -47. Competing interests: None declared |
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Michael D Innis, Director Medisets International Home 4575A
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Editor, Richard Horton’s reference to “Andrew Wakefield’s extreme and unsubstantiated claims about the safety of MMR” [1] is just one example of the misunderstanding among medical professionals regarding the safety OR otherwise of vaccines. Andrew Wakefield [2] has demonstrated, to those who can understand his work, that SOME vaccines, by virtue of their antigenic constituents, are causing Immune Hypersensitivity Reactions in SOME children. The types of Hypersensitivity Reactions vary with the type of vaccine and the genetic constitution of the individual. Type I reactions are those in which Histamine is liberated and results in a precipitous fall in Vitamin C . Kalokerinos [3] and Clemetson [4,5] advice administration of Vitamin C prior to Vaccination to avoid a catastrophic bleeding disorder which has hitherto been termed the “Shaken Baby Syndrome”[6] Type III reactions are those which Wakefield and his colleagues describe and are typically the result of Immune Complexes formed by MMR Vaccination. The lodgement of these complexes in the Brain and Ileum account for the symptomatology of Autistic Spectrum Disorder. It would be a very simple task for the Medical Research Council to confirm or negate these assertions by looking for evidence of Histaminaemia and Immune Complexes and comparing affected and unaffected children. A few tests such as: 1.Determining the level of Histamine in the blood as suggested by Clemetson 2.Blood Levels of Acute Phase Reactants 3.Hypersensitivity Skin Reactions to MMR vaccine 4.Cryoglobulins, Complement levels, ANCA and AECA in blood 5.Raji Cell tests would settle the matter - in favour of Kalokerinos, Clemetson, Wakefield and colleagues. Without a doubt. Michael D Innis FRCPA; FRCPath References: 1.Horton R. Another View Rapid Responses 12th December 2003 2.Ashwood P Anthony A, Torrente F, Wakefield AJ. Spontaneous mucosal lymphocyte cytokine profiles in children with autism and gastrointestinal symptoms: mucosal immune activation and reduced counter regulatory interleukin-10 journal of clinical immunology, vol. 24, no. 6, november 2004 ( c_2004) 3. Kalokerinos A. Every Second Child p38. Foreword by Linus Pauling.Introduction by Irwin Stone. Keats Publishing , Inc New Canaan Connecticut 4 Clemetson CAB Barlow’s disease. Medical Hypotheses (2002);59(1) 52 -56 5. Clemetson CAB Vaccinations, Inoculations and Ascorbic Acid. J Ortho Mol Med (1999) vol 14 No 3 137 – 142 6. Brian Harding, R Anthony Risdon, and Henry F Krous Shaken baby syndrome BMJ, Mar 2004; 328: 720 - 721. Competing interests: As previously declared |
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Susan K Hamlyn, Writer/teacher W5 5PB
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One thing that does not help in this debate is the labelling of parents who allege that their children have been damaged by a vaccine as 'the anti-vaccine lobby'. That they are not 'anti-vaccine' should be self- evident. Competing interests: Mother of one of the claimants in the MMR litigation. |
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