Vaccination and Health Outcomes

Dear Colleagues,

About 95% of US children receive all of the recommended vaccines, and full vaccination is increasingly required for daycare and school attendance in the US and many other countries. New vaccines are also in development for children and adults. While vaccines have a strong safety profile, over $3 billion has been paid by the US Vaccine Injury Compensation Program for vaccine-associated injuries and deaths, and only about 1% of vaccine-associated injuries are officially reported to the Vaccine Adverse Events Reporting System. 

The long-term effects of vaccination on children’s health remain virtually unknown but are assumed to be limited solely to prevention of the targeted disease. Studies have been recommended by the Institute of Medicine to address this question. However, randomized controlled trials, the “gold standard” for such research, have been considered unethical because they normally involve depriving some children of the needed vaccines in order to create a control group. Vaccines also have a quasi-religious status as a “sacred cow” of medicine and public health, which has discouraged scientific inquiry, and critics are often attacked personally and pejoratively labeled as “anti-vaxxers”. Although it is well known that deaths from common infectious diseases declined dramatically before the advent of most vaccines due to improved environmental conditions (even diseases for which there were no vaccines), the worry is that criticism of vaccines could escalate to the point where parents become reluctant to vaccinate their children and once-dreaded diseases will return in full force. 

Yet it is in the public interest to determine the long-term outcomes of mass vaccination. In the absence of such data, potential harms from the schedule will remain unknown. For instance, research by Peter Aaby and associates has shown that common vaccines have non-specific effects in addition to prevention of targeted infections, and these effects depend in part on the order in which vaccines are administered. In some cases, the outcomes are beneficial; in others they can be harmful. During the same recent period in which the pediatric vaccination schedule has been greatly expanded and accelerated, there has been a parallel increase in childhood allergies and neurodevelopmental disorders (NDDs). It is unclear if these changes are related.

Although randomized controlled trials may not be feasible, other research designs are possible, such as comparative studies of vaccinated and unvaccinated children. In a recent study by the author and colleagues (Mawson et al., 2017a,b), the health outcomes of vaccinated and unvaccinated homeschool children were compared, based on mothers’ anonymous reports. Mothers were asked to complete an anonymous online questionnaire on their 6- to 12-year-old biological children with respect to pregnancy-related factors, birth history, vaccinations, physician-diagnosed illnesses, medications and the use of health services. A convenience sample of 666 children was obtained, of which 39% (261) were unvaccinated.  While the vaccinated were significantly less likely to have been diagnosed with chickenpox and whooping cough, they were significantly more likely than the unvaccinated to have been diagnosed with allergic rhinitis, eczema, attention deficit disorder, autism spectrum disorder, a learning disability, middle ear infection, and pneumonia. After adjustment, the factors of vaccination, male gender, and preterm birth remained significantly associated with neurodevelopmental disorders. However, in a final adjusted model with interaction, vaccination but not preterm birth remained associated with NDD, while the interaction of preterm birth and vaccination was associated with an apparent synergistic 6.6-fold increased odds of NDD (95% CI: 2.8, 15.5). Thus, vaccinated homeschool children were found to have a higher rate of allergies and NDD than unvaccinated homeschool children. Further research involving larger, independent samples is needed to verify and understand these unexpected findings in order to optimize the impact of vaccines on children’s health. Research is also focusing on vaccine ingredients that could be potential mechanisms of vaccine-associated injury, including mercury and aluminum. However, other voices claim that such findings, based on small samples and self-reports, are invalid; that alleged links between vaccines and NDDs are spurious; and increases in autism in particular are due to the widespread use of agricultural chemicals.

To encourage further research on the long-term health effects of vaccines, IJERPH is inviting contributions for a Special Issue titled, “Vaccination and Health Outcomes”.  A wide range of submissions are welcomed, including reports of new findings, reviews of the literature, commentaries on recent publications, and new hypotheses.

References

Mawson, A.R.; Ray, B.D.; Bhuiyan, A.R.; Jacob, B. Pilot comparative study on the health of vaccinated and unvaccinated 6- to 12-year-old U.S. children. J. Transl. Sci. 2017, 3(3), 1–12, doi: 10.15761/JTS.1000186. http://wwwNaNsri.org/wp-content/uploads/2017/05/MawsonStudyHealthOutcomes5.8.2017.pdf

Mawson, A.R.; Bhuiyan, A.Z.; Jacob, B.; Ray, B.D. Preterm birth, vaccination and neurodevelopmental disorders: A cross-sectional study of vaccinated and unvaccinated children. J. Transl. Sci. 2017, 3(3):1–8, doi: 10.15761/JTS.1000187. http://wwwNaNsri.org/wp-content/uploads/2017/05/MawsonStudyPretermBirth5.8.2017.pdf

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• chronic diseases
• epidemiology
• evaluation
• health policy
• immunization
• vaccination
• neurodevelopmental disorders
• allergies
• autism spectrum disorder
• health disparities
• genetics
• pathogenesis
• aluminum
• mercury
• health outcomes
• birth outcomes
• preterm birth