Meta-Analysis: Vaccines and Autism
Discuss about the Evidence Of The Immunisation Safety.
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Source of information |
Type of information |
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Australian Government, Department of Health website |
The Australian Immunisation Handbook (2017) |
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Government of Western Australia |
Healthy information for Western Australia website |
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MMR Decision Aid |
A decision aid that provides information to parents and public whether to immunise their child with MMR vaccine or not |
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Keyword |
Search term for Boolean ‘or” |
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vaccination |
Immunisation |
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Vaccination in children |
Vaccination and immunisation in children |
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MMR vaccine |
Benefits of MMR vaccine |
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Vaccine and autism |
Disadvantages of vaccine |
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Two combined doses of MMR |
Benefits of two doses over monovalent dose |
If my search failed to find quality articles based on my research question, the first action is to change the search terms or phrases. It is important to change the keywords that can help me to get satisfactory articles. Moreover, the databases need to be selected again from the list and conduct the searches so that appropriate literature is found. I also have to consider the research question ensuring that it is not too narrow or broad. I will read the abstracts of the articles carefully so that it can save my time.
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Table 1 : Meta-analysis (systematic review) |
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Full reference |
Taylor, L.E., Swerdfeger, A.L. and Eslick, G.D., 2014. Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine, 32(29), pp.3623-3629. |
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Search Strategy |
“Vaccines” “autism” keywords are used to search papers in the databases like CINAHL, Web Search. Moreover, Boolean operators like ‘AND’ and ‘OR’ is used. For this paper, articles published after the year 2012 to 2014, full-text articles published in English were considered. Out of 6 articles, this article was chosen that fulfilled the eligibility criteria. |
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Inclusion/exclusion criteria |
A meta-analysis was performed where evidence was gathered from cohort and case-control studies in databases on the topic of autism and vaccines in PubMed, MEDLINE, Google Scholar, and EMBASE up to April 2014. |
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Issue |
In the current public health, there is an ongoing debate that there is a possibility of development of autism due to childhood vaccination. It has emerged as a serious public health issue where parents are not willing to get their children immunized. MMR vaccine has been considered to be the major cause of autism development and there is distrust among the parents and caregivers that childhood vaccination is a causal factor for autism. Therefore, in the modern day society, there is a decision to opt out MMR vaccine from vaccination schedules as it concerns development of autism. |
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Study setting |
A meta-analysis was performed for quantitative assessment of available data from research conducted in various countries regarding autism development and childhood vaccination. PRISMA was conducted for meta-analysis and review of literature. |
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Main findings |
The cohort studies and meta-analysis of five studies showed no evidence that there was no link between childhood vaccination and subsequent risk for autism development. Four of the five studies included in the study showed that there was no link between autism and vaccine. As there is no link, it is advisable that MMR vaccine should be included in the current immunisation practices. The study revealed that autism development is multifactorial that involves genetics and brain inflammation that is caused by environmental toxins. |
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Table 2 : Qualitative study |
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Full reference |
Guillaume, L.R. and Bath, P.A., 2004. The impact of health scares on parents’ information needs and preferred information sources: a case study of the MMR vaccine scare. Health Informatics Journal, 10(1), pp.5-22. |
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Search Strategy |
“MMR vaccine and information”, “parents information scare” “impact of health scarce” keywords were used. The Boolean operators AND and OR were used and full-text papers published after 2000 and English were considered for the study. The databases PubMed, CINAHL and Google Scholar was searched. |
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Inclusion/exclusion criteria |
Semi-structured interview was conducted for the study where the parents were interviewed and was allowed to expand their answers as they adhered to the proposed structure. A purposive sampling strategy was adopted for recruiting parents of children below the age of five years based on data collected from childcare organizations in community. The study included parents whose children were due vaccination or recently vaccinated. Inductive approach was used for data analysis and thematic analysis was done from the interview study as a part of large-scale study. |
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Issue |
Health scares is a modern phenomenon that is characterized by reporting of mass media that creates panic among the public regarding any intervention or particular health issue. There is little research conducted for examining the non-medical effects of health scares and its effect on information behaviour and needs. Therefore, this is the first study that was aimed to investigate the impact on parents due to health scares, its effects on information needs and information resources that parents need for gaining information. |
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Study setting |
The study was conducted in February 2002 at the time of measles outbreak in Newcastle and London that was mentioned previously for empirical study data collection. MMR vaccination scare and issues surrounding it attracted parents of children. |
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Main findings |
The main findings of this exploratory study suggested that scare information on MMR contribute to emerging issues for the parents. The study suggested that value judgements need to be made about the authenticity and trustworthiness of information gathered from media before accepting it. The parents informed that when they encounter scare, there is a need for information about various MMR vaccine aspects that remains unmet. The study also highlighted that parents were critical of government where they thought that MMR vaccines is done for economic reasons and viewed it as dogmatic in response to concerns of parents. |
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Table 3 : Quantitative study |
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Full reference |
Prymula, R., Bergsaker, M.R., Esposito, S., Gothefors, L., Man, S., Snegova, N., Štefkovi?ova, M., Usonis, V., Wysocki, J., Douha, M. and Vassilev, V., 2014. Protection against varicella with two doses of combined measles-mumps-rubella-varicella vaccine versus one dose of monovalent varicella vaccine: a multicentre, observer-blind, randomised, controlled trial. The Lancet, 383(9925), pp.1313-1324. |
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Study design |
The first phase of the study was conducted from Sept 2005 to June 2009 where 5803 children were vaccinated. A randomized, observer-blind controlled trial was conducted in around 111 centres in European nations. |
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Population |
The participants for the study comprised of eligible participants aged 12-22 months at the time of first vaccination and negative MMR diseases. Any participant who had one sibling negative with MMR, childminder (without a known history of varicella), registered to daycares and or weekly more than 5 minutes without a known varicella disease history and vaccination were considered for the study. The participants were randomly allocated to one of three treatment groups in the ratio (3:3:1) for studying monovalent and two doses of combined MMR vaccine. 200 participants per country were included for the study. |
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Intervention |
In more than 5000 children, two dose MMR vaccine against varicella was almost 95% and provided vaccination against severe forms more than 99%. This intervention showed greater protection against the infection. |
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Comparison |
The intervention of two doses of combined MMR vaccine was compared to monovalent dose and it was found to be less effective as compared to the intervention. |
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Main findings (outcome) |
The findings suggested that after dose one administration, 57.4% of participants in the MMR vaccine group reported 38° fever, however, about 44.5% with MMR+V and 39.8% with MMR. This suggests that short course administration of MMR vaccine ensure to provide optimal protection from varicella infection as compared to monovalent dose from all forms of the infection. |
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Table 4 : Case control study (observational study) |
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Full reference |
Uno, Y., Uchiyama, T., Kurosawa, M., Aleksic, B. and Ozaki, N., 2012. The combined measles, mumps, and rubella vaccines and the total number of vaccines are not associated with development of autism spectrum disorder: the first case–control study in Asia. Vaccine, 30(28), pp.4292-4298. |
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Search Strategy |
For the study, the search key terms used were MMR vaccines and autism spectrum disorder (ASD). The papers from the year 2012 onwards were taken, full-text articles and published in English. |
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Inclusion/exclusion criteria |
189 cases and 224 controls were taken that matched for diagnosed with ASD, born between April 1 to 30 from 1984 to 1992 for MMR vaccination were included. The subjects whose records were illegible or missing from the Maternal and Child Health (MCH) handbook and history of vaccination from another country were excluded from the study. |
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Issue |
There is less number of reports on MMR vaccines and parents or guardians are apprehensive about their children getting immunised and perceived risk for ASD. Therefore, this is the first study conducted in Japan (Asia) where the MMR vaccine is linked to ASD development. |
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Study setting |
The study was conducted in Yokohama Psycho-Developmental Clinic (YPDC), Kanto area, Japan and patients who were suspected with developmental disorders from April 1997 until March 2011 were included. |
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Main findings |
Considering the perinatal, prenatal and neonatal factors, no significant differences were found between controls and cases. The conditional multiple regression model showed that there were no significant differences between the two groups. Therefore, the findings suggested that no convincing data showed MMR vaccination and ASD development. This finding indicates that there is no reason for MMR vaccine avoidance concerning ASD development. |
The above studies are relevant to the research question as it suggests that immunisation is safe for children and parents should get them immunised to protect them from infectious diseases. There is controversy that MMR vaccine is linked to ASD and colitis as per a fraudulent research paper published in 1998. Parents are concerned about getting their children vaccinated as there are three specific hypotheses made: the combination of MMR damages intestinal lining, thimerosal, a preservative is toxic to CNS and vaccines stimulation weakens immune system (Brown et al. 2012). These hypotheses concerns parents and therefore, the first and fourth evidence of systematic review and case-control study respectively highlighted that there is no risk for ASD due to MMR vaccine. The fact is each family has experience with autism and that corresponds to vaccination timings of the child. This concerns parents and research over two decades showed that there is no relationship between autism and vaccine of any kind. Moreover, scare health information and unmet needs of parents concerning vaccines need to be fulfilled so that they take an active part in the immunisation process protecting their children from preventable infectious diseases (Dubé et al. 2013). In addition, the quantitative study in table 3 suggested that two doses of MMR vaccines are more effective than monovalent dose. These studies greatly support my research question suggesting that there is no risk for any kind of disease or developmental problem due to vaccines. As a nurse, I need to provide this gathered evidence to the parents and advocate that immunisation is important and continuation of programs should be encouraged according to the national guidelines.
From the above literature evidence, it can be concluded that immunisation is safe for the children and parents should get them immunised in order to protect them from infectious diseases. There is no such evidence that shows risk of autism is linked with immunisation. Many parents refuse immunization as they feel that getting their children immunized make them get the disease before it develops. There is no such evidence and vaccines not only help to protect children, but also benefit the entire population from the spread of disease. Vaccines are not associated with any sort of risk and parents need to encourage immunization and should not avoid it on any grounds.
References
Bärnighausen, T., Bloom, D.E., Cafiero-Fonseca, E.T. and O’Brien, J.C., 2014. Valuing vaccination. Proceedings of the National Academy of Sciences, 111(34), pp.12313-12319.
Brown, K.F., Long, S.J., Ramsay, M., Hudson, M.J., Green, J., Vincent, C.A., Kroll, J.S., Fraser, G. and Sevdalis, N., 2012. UK parents’ decision-making about measles–mumps–rubella (MMR) vaccine 10 years after the MMR-autism controversy: A qualitative analysis. Vaccine, 30(10), pp.1855-1864.
Dubé, E., Laberge, C., Guay, M., Bramadat, P., Roy, R. and Bettinger, J.A., 2013. Vaccine hesitancy: an overview. Human vaccines & immunotherapeutics, 9(8), pp.1763-1773.
Guillaume, L.R. and Bath, P.A., 2004. The impact of health scares on parents’ information needs and preferred information sources: a case study of the MMR vaccine scare. Health Informatics Journal, 10(1), pp.5-22.
Harmsen, I.A., Mollema, L., Ruiter, R.A., Paulussen, T.G., de Melker, H.E. and Kok, G., 2013. Why parents refuse childhood vaccination: a qualitative study using online focus groups. BMC Public Health, 13(1), p.1183.
Prymula, R., Bergsaker, M.R., Esposito, S., Gothefors, L., Man, S., Snegova, N., Štefkovi?ova, M., Usonis, V., Wysocki, J., Douha, M. and Vassilev, V., 2014. Protection against varicella with two doses of combined measles-mumps-rubella-varicella vaccine versus one dose of monovalent varicella vaccine: a multicentre, observer-blind, randomised, controlled trial. The Lancet, 383(9925), pp.1313-1324.
Taylor, L.E., Swerdfeger, A.L. and Eslick, G.D., 2014. Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine, 32(29), pp.3623-3629.
Uno, Y., Uchiyama, T., Kurosawa, M., Aleksic, B. and Ozaki, N., 2012. The combined measles, mumps, and rubella vaccines and the total number of vaccines are not associated with development of autism spectrum disorder: the first case–control study in Asia. Vaccine, 30(28), pp.4292-4298.
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