"Good morning and congratulations on the new baby." The new parents look up at me with a beaming smile and a nod of the head. "I have a few things to go over with you and a consent form to sign for his hepatitis B shot." Their proud smiles quickly turn to a look of worry as they glance at each other for a moment before turning to me and asking "We have heard some horror stories in regards to immunizations and we are not sure what we should do? What is your opinion?" I choked back the words that initially sprang forth as a flashback overwhelmed me.
The feeling of panic and doom overwhelmed me as I clutched my daughters convulsing body tight. "Jena don't leave me baby girl, how could you do this god, Mama's right here stay with me, God please don't take her from me, Mama Loves you Jena please don't let go! MOM, DO SOMETHING. DRIVE FASTER! I'M LOSING MY BABY!" Her eyes rolled backwards into her head as her tiny body continued to convulse violently. Before I knew, I was on my knees in the emergency room hall watching the nurse whisk my daughter away shouting orders STAT and calling for the doctor. "Come with me Hun." A voice broke through thoughts of my daughters' possible death and the cries of horror I was letting out. "Your daughter has a fever of 106.9; how many days has she been sick?" I wiped the tears from my eyes and swallowed down the fear for a moment; "she's not sick she just had her checkup with the doctor earlier today. He said she is a very healthy happy baby, then the nurse gave her an MMR shot and we went home. She was fine until this started and we came straight here."
"Miss?" the father's voice snapped me back into the present. Thoughts swirled through my head as I struggled to find an appropriate response to their very common question regarding immunizations. A very big part of a nurse's job is to educate the community on preventative care including immunizations. I know I am supposed to tell them that vaccines are safe and are not only highly recommended but required before the child goes to school. How can I tell them this knowing the real risks of immunizations? I sacrificed my daughter for the greater good and live in regret every day. If I had known 11 years ago what the last 5 years of researching this topic has taught me, my daughter would not be struggling with Aspergers today.
My intent in writing this paper is not to turn the audience against vaccines, but to argue for a solution that nurses can offer. I will give a brief overview of some of the highlights in the history of immunizations, autism and the debate. I will show how this debate affects nurses and how nurses can offer a realistic compromise that both sides could live with. Nurses should be required to inform parents of the possible rare adverse effects and offer alternative immunization schedules. If nurses inform parents of the possible alternatives it may lead to more kids being immunized against deadly childhood diseases, as opposed to continuing to put our youth at risk in the current herd immunity situation we are in.
Diphtheria vaccine was first licensed in 1921, Pertussis and Tetanus mid-1940s. Measles vaccine first used in 1963, Mumps 1967, Rubella 1969 all were separate immunizations until 1971 when MMR (measles, mumps, and rubella), the first three in one vaccine was developed. In the 1980s there were ten scheduled immunizations a child would receive before school age. Currently, our youth receive 31 immunizations before reaching the age of two years.
In 1943 what we now know as autism spectrum disorders (ASD) was first discovered and viewed as being an extremely rare behavioral disorder brought on by a mother's negligent care. The earliest records show that from the 1960s to 1970s the incidence of ASD's was 5 in 10,000. In 1980 ASD was officially added to the Diagnostic and Statistical Manual Disorders. In 1986 the incidence was recorded at 1 in 500, mid-1990's 1 in 250. Today the numbers reflect 1 in 80-110 kids have some form of ASD. "Bernard Rimland, Ph.D., founder of the Autism Society of America and founding president of the Autism Research Institute (ARI), has thoroughly analyzed the ARI database of more than 30,000 entries and reported two clear trends: First, the incidence of autism has increased remarkably, becoming "an explosion~~ in recent years and second, a distinct shift in the time of onset of autistic symptoms has become evident. "Late onset autism (starting in the second year) was almost unheard of in the 1950s, '60s, and '70s; today such cases outnumber early onset cases five to one." (F. Edward Yazbak, M.D., F.A.A.P., 2003). This correlation gave reason to investigate further into the relationship between immunizations and autism spectrum disorders.
The debate began in 1998 when Dr. Wakefeild published an article in the Lancet indicating a possible link between the MMR vaccine and ASD's. Although his work was discredited on false allegations, many continue to study the possible link. The CDC responded by financing a study in Denmark. This study followed kids from birth to five years all vaccinated on the Danish schedule. The results showed no correlation between vaccines and ASD. Ironically almost all parents claiming their child was vaccine injured was not diagnosed until 6-10 years of age, convenient for the CDC that the study would stop at 5 years. The CDC fails to mention that the Danish population has one of the lowest incidences of ASD in the world and also have a different immunization schedule. Other studies looked at the effects of ethyl mercury that is used as a preservative in the immunizations. They found that methyl mercury which had been used in all previous studies to test the safety of ethyl mercury in vaccines was almost all excreted from the body while up to 86% of the ethyl mercury crosses the blood brain barrier where it is trapped causing neuro degeneration and inflammation. This proved that previous methods using methyl mercury to test the safety of ethyl mercury in vaccines was inappropriate. (Wright,2007 p.144) Following this discovery, a Scientific Review of Vaccine Safety Datalink Information was held in 2000. According to Russell Blaylock in "The Truth Behind the Vaccine Cover-up" (2008), during this meeting, it was acknowledged that the amount of mercury in vaccines greatly exceeds safety guidelines to the point that neurological damage was possible.
The long term goal was to remove ethyl mercury from all vaccines as soon as possible. It was decided that the current ethyl mercury containing vaccines could be used until new mercury free vaccines could be manufactured at their earliest convenience. It was not until 2003 that the last of the ethyl mercury containing vaccines expired, however the annual flu shot, the MMR and DTaP continue to use ethyl mercury to attenuate the virus. Many other studies have shown that it is not only the mercury that is damaging but the frequency of immunizations in the underdeveloped brain. Most recent was a study done by the University of Pittsburg and Thoughtful House Center for Children in Autism of which findings were published in Neurobiologiae Experimentalis in 2010. They found that primates, vaccinated with the required CDC schedule at equivalent ages to the recommended age of vaccinations, were shown to have an increase in brain volume, specifically the areas associated with emotional responses, similar to children with ASD (Olmsted, Blaxill, 2010). Studies continue today to provide scientific evidence of the damage caused by vaccines, however, every study brought forth to the CDC is dissected scrutinized and tossed aside. To date, the CDC has yet to produce any scientific evidence that the vaccines they are requiring are safe.
CDC is so intent on convincing people that the vaccines are safe yet on the CDC website it clearly lists brain damage and seizures as adverse effects of many immunizations. Specifically the MMR indicates "Severe problems (rare)- deafness, long term seizures, coma, permanent brain damage. Moderate Problems-temporary pain and stiffness, temporary low platelet count, and seizure (jerking or staring) caused by fever" (Center for Disease Control, 2011). And there it is! The hallmark febrile seizure reported by almost 100% of parents claiming to have a vaccine injured child. They claim their child experienced a febrile seizure just hours, days or even weeks after receiving the MMR vaccine leading to developmental regression and ultimately a diagnosis of late onset ASD.
One may ask; what does all of this have to do with nurses? I ask; how can nurses not be involved and concerned? Nurses primarily are the ones on the front lines promoting the CDC immunization schedule. They encourage parents to vaccinate their children for their health and safety. Nurses are the ones who ask parents to sign the informed consent stating that they have been told of the benefits and risks. Nurses frequently administer the immunizations to kids. It is not the CDC or the Pharma-Nazis as Dr. Eisenstein refers to the pharmaceutical companies in his book Make an Informed Vaccine Decision (2010) but nurses who are blindly injecting our youth with a cocktail that has never been scientifically proven safe. A survey done on random pediatric offices across the nation showed that nurses play a vital role in the immunization program through education and administration (David et al., 2001). Nurses are held accountable for educating themselves and patients of the potential adverse reactions to medications that they give every day, immunizations are no exception.
The current protocol is that nurses hand parents a packet of information regarding the benefits and risks of immunizations just minutes before injecting their child. Let's be honest for a moment though. How many parents actually read the entire packet and for that matter how many nurses have ever read it themselves. A recent study was done to determine the level of knowledge of immunizations among parents both new parents and parents with more than one child. Out of 30 parents, only four knew the name and purpose of the immunizations their child/children had received (Baker, Wilson, Nornstrom, & Legwand, 2007). The results are screaming for in depth public education on immunizations. "It takes someone who can be trusted, someone who can counter their concerns with good science. Because nurses often administer the vaccines, they usually spend more time with parents. They're in the best position to answer parents questions." (Wallis, Kennedy, & Jaccobson, 2009) A self report survey looked at the risk/benefit communication in private practices. Seventy percent of nurses and physicians self reported initiating education in regards to common side effects, when to call the office and the immunizations schedule, 40% of those did not mention risks at all (David et al., 2001). It seems our government is taking an all or none stance, forcing parents to blindly immunize their kids or face consequences in the court of law.
Nurses need to take initiative to educate themselves on the topic in order to educate the parents and be ready to answer whatever questions may arise. Nursing schools should educate future nurses about the debate and prepare them for the questions that a skeptical parent may have. Teach them the possible alternatives for parents who would otherwise choose not to immunize at all. Today it is relatively simple to Google just about any information you want. Parents can easily be frightened by the hundreds of anti-vaccine sites or even the list of adverse effects on the Center for Disease Control website. If you look at the side effects of immunizations almost all of them indicate some sort of rare but possible CNS or brain related injury, easy to see why many parents are opting to go vaccine free. Failing to educate parents can become a missed opportunity to ease the mind of an anti vaccine parent; a missed chance to allow a parent to consider an alternative. The most popular choice among many parents and physicians is the Danish schedule. They have fewer vaccines delayed until the child is at least three months of age. They then receive a few shots at five months, then 12 months, 15 months, four and five years and 12 years, a total of 11 shots in 12 years, only seven prior to their second birthday. The schedule only includes the higher priority vaccinations which are; MMR, DTaP (diphtheria, tetanus, and Pertussis), IPV (inactive poliovirus), Hib (Haemophilus influenza type B) and PCV (Pneumococcal conjugate vaccine) (Janak, 2008). This is a far cry from the U.S. schedule, vaccinating against anything possible, including the less than deadly chicken pox for a total of 31 in the first 2 years. When we offer them a choice we put the control back in the parent's hands, if truly educated about the risks and benefits by a caring intelligent nurse we may see a rise in the number of children that receive immunizations, maybe on the alternative schedule, but at least they will be protected.
Currently, we are lucky that we have not seen a major rise in preventable childhood diseases. We owe our thanks to herd immunity. As long as more people are immunized than not, the virus has little opportunity to infect anyone. This is another common reason for parents to assume the immunizations are not necessary. They have not seen the devastating effects of a measles outbreak or Pertussis, therefore the thought of what could happen without immunizations is unimaginable to the parents of today. Bottom line is this; whether we like it or not there are more and more parents refusing immunizations based on the scientific studies that have shown how devastating the adverse effects can be. This is a trend that will not be easily put to rest. At the same time, we can not afford to backtrack 60 to 100 years when deadly childhood diseases were common and it was expected to lose at least one child in a family before reaching five years of age. Parents need to be told of the serious consequences of not immunizing while respecting their legitimate fears of the possible adverse effects. Offering the alternative schedule may lead to more parents choosing to immunize with fewer chances of adverse effects. Some studies have shown that higher educated parents are more likely to refuse than those who have little more than a high school diploma (Vaccine Awareness, n.d.). To back my theory that better education and offering an alternative schedule may change the minds of anti vaccine believers, I conducted a poll on a very popular social networking website. Due to the limited function of the application used I was only able to ask 2 simple questions. 1. Do you believe immunizations can cause ASD's? 2. If you were offered a safer alternative schedule with fewer more spread out vaccines would you choose this option to vaccinate your children? I had 27 both distant friends and anonymous strangers reply. Sixteen (more than 50%) answered yes they believe vaccines can cause ASD's and yes they would use the alternative schedule if offered. The rest either responded that they did not believe that vaccines cause ASD's or that they were unsure. Only one responder answered yes they believed that vaccines cause ASD's but no they would not vaccinate on an alternative schedule. This supports my theory that if parents are given the choice many will continue to use the current CDC schedule but many of those who would opt to not vaccinate, would use an alternative schedule if offered (Noyes, n.d.).
In virtue of the immunization/autism debate, we are seeing a steady incline of parents refusing vaccines due to legitimate fears of adverse reactions. If nurses are better educated themselves on the debate they can be prepared to support the decisions of parents and seize the opportunity to help clarify the benefits and risks of immunizations. Nurses can offer a conservative alternative to not immunizing for those who are unaware that there are other options available but would not choose to immunize on the current schedule. This will climactically lead to more children being vaccinated against the more threatening deadly childhood diseases with fewer adverse reactions. It is better to have some protection at least against deadlier diseases rather than no protection at all.
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