Health Promotion Controversy: MMR Vaccine

“Vaccines are one the greatest scientific inventions available to prevent illness and death” (Papachrisanthou & Davis, 2019, p. 391) even though they are highly controversial.  Over the past several years, this topic has been a center of debate for many parents.  The study published in

Lancet

in 1998 by Andrew Wakefield started the debate. This study only had 12 participants and suggested the MMR vaccine causes autism (Knopf, 2017).

Lancet

retracted the study in 2010 because it was found to have inconsistency in data that was not supported by evidence-based research (Hviid, Hansen, Frisch, Melbye, 2019).  Even though measles was declared eliminated in 2000, there has been an increase in individual cases of measles since the Wakefield report.  The increase in measles cased is due to the negative publicity of the link between autism and the MMR vaccine.  The CDC reports most of the people who report having the measles are unvaccinated (2019).  There have been several studies performed, and not one could prove there is a “link between autism and the MMR vaccine” (Offit, 2015, p. 12236).  This paper will disseminate the evidence for and evidence against the MMR vaccination and provide evidence-based recommendations for parents whose children need protection against these diseases.

Evidence in Favor

The MMR vaccine protects the child, family, and community from measles, mumps, and rubella, and eliminate the resurgence of measles, mumps, and rubella. Possible complications from the measles are “bronchopneumonia, laryngotracheobronchitis, and encephalitis” (CDC, 2019).    The measles vaccination gives a lifetime immunity from the disease and its complications.  The vaccines enable the body to develop protection against the pathogen it targets (CDC, 2019).  If everyone receives the vaccine, they are less likely to catch measles, mumps, or rubella virus.

The measles vaccine was introduced in the U. S. in the early 1960s, and forty years later was considered eliminated (Papachrisanthou & Davis, 2019, p. 391).  There have been measles cases in unvaccinated people that traveled and infected, by random contact, other unvaccinated individuals (Papachrisanthou & Davis, 2019, p. 391).  The unvaccinated individuals could have been immunocompromised, too young to receive, or chose not to receive the vaccine themselves.  These unimmunized individuals, for whatever reason, caused several thousand people to spread the measles virus into the community (Papachrisanthou & Davis, 2019, p. 391).

Evidence Against

Many people believe vaccines are ineffective and unsafe.  There is a high level of mistrust of public health officials in people who are against vaccinations.  Many vaccine-hesitant people believe the immune systems should be built up, and they think this can be accomplished by not being immunized.  Public trust in regards to vaccines has waned, because of mistrust of the pharmaceutical companies.   The evidence against the MMR immunization comes from misleading information regarding autism and the MMR vaccine.  No evidence-based data supports not getting the MMR vaccine.  Over the past several years, there has been controversy regarding a possible association between the autism and the MMR.  Many parents believe there is a connection between autism and MMR immunization because the prevalence of autism has increased.  The first MMR immunization is given between “12 months and 15 months,” and the second MMR immunization is given between “four and six years old” (CDC, 2019).  The American Academy of Pediatrics (AAP) (2018) recommends screening for Autism Spectrum Disorder (ASD) for all children at the 18-month and 24-month well-child checkups” (Christensen et al., 2018, p. 4).  The recommended screening for autism comes immediately after the immunization for the measles, mumps, and rubella

Advice for Parents

As a healthcare provider, I would advise parents to immunize their children based on my research and that of the entire healthcare community.  A national cohort study reported no “increased risk for autism to children who received the MMR vaccination” (Hviid et al., 2019, p. 519).  The measles outbreak is associated with the failure to get the MMR vaccine because of the parent’s fear of their child getting autism after MMR immunization (Hviid et al., 2019).

I agree with the current immunization guidelines set forth by the Tennessee Department of Health (2019).  As a healthcare provider, I will advise parents of the importance of mandatory immunizations as well as recommended vaccinations.  Vaccines are essential for continued health and wellbeing of the children as well as the community.  As an advanced practice nurse, we must promote health and prevent illness by advocating for the patient and educating the parents.

Conclusion

In conclusion, if we want to avoid future measle outbreaks we must direct our efforts to families who are least likely to vaccinate their children.  Education is the key to changing the mindset of these parents.  The choice is ultimately the parent’s decision whether or not they are comfortable giving immunizations to their children.  The parent must realize their decision will not only affect their own family, but will affect other families, their friends, and their community.  As healthcare providers, we have a responsibility to address parental concerns and share information about immunizations.  We can create awareness to dispel false truths associated with vaccinations.  By addressing these concerns, educating, and sharing this information, the parents will have increased knowledge based on facts, not fraudulent claims.

References

• Centers for Disease Control and Prevention (CDC). (2019). Measles: For healthcare professionals. Retrieved from https://www.cdc.gov/measles/hcp/index.html
• Christensen, D. L., Braun, K., Baio, J., Bilder, D., Charles, J., Constantino, J. N., … Yeargin-Allsopp, M. (2018). Prevalence and characteristics of autism spectrum disorder among children aged 8 Years – autism and developmental disabilities monitoring network, 11 sites, United States, 2012.
  
  Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002)
  
  ,
  
  65
  
  (13), 1–23. Retrieved from doi:10.15585/mmwr.ss6513a1.
• Hviid, A., Hansen, J.V., Frisch, M., & Melbye, M. (2019, April 16). Measles, mumps, rubella vaccination and autism: a nationwide cohort study.
  
  Annals of Internal Medicine.
  
  170 (8) Retrieved from doi:10.7326/M18-2101.
• Knopf, A. (2017). Vaccines do not cause autism: Pediatricians fight back against anti-science.
  
  Brown University Child & Adolescent Behavior Letter
  
  ,
  
  33
  
  , 1–2. https://doi:10.1002/cbl.30195
• Offit, P. A. (2015). Vaccines and autism in primate model.
  
  Proc Natl Acad Sci U S A
  
  . 2015;112(40), pp. 12236-12237. Retrieved from doi:10.1073/pnas.1516574112.
• Papachrisanthou, M. M., & Davis, R. L. (2019). The Resurgence of Measles, Mumps, and Pertussis.
  
  The Journal for Nurse Practitioners
  
  ,
  
  15
  
  (6), 391–395.  Retrieved from https://doi:10.1016/j.nurpra.2018.12.028.
• Tennessee Department of Health. (2019). Immunization Program. Retrieved from https://www.tn.gov/health/cedep/immunization-program.html.