February 9, 2001

VUMC faculty comment on NEJM vaccine study

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Country music artist Skip Ewing embraces his daughter, Rebecca, after their run in the celebrity ski race. Rebecca not only beat her dad but had a time of 19 seconds – better than many adults in the contest. (photo by Cynthia Manley)

VUMC faculty comment on NEJM vaccine study

Time has changed the way both the health care community and the public view immunizations.

Just years ago, medical students and residents wrote “UCD” on patient histories, an acronym for “Usual Childhood Diseases.” Now they’re called “Vaccine Preventable Diseases.”

Last year, when Dr. Bruce Gellin, adjunct assistant professor of Preventive Medicine asked how many members of a first-year class had seen measles, only those who had traveled outside of the United States raised their hands.

“What is entirely lost is first hand knowledge of the diseases that vaccines have effectively prevented,” Gellin said. “Now the focus is on the vaccines.”

Gellin and Dr. William Schaffner, professor and chair of Preventive Medicine, wrote an editorial in the Feb. 1 edition of The New England Journal of Medicine that accompanied two studies showing there is no relationship between the hepatitis B vaccination and multiple sclerosis.

Concerns that the vaccine may trigger MS led some countries and consumer groups to question its use, particularly in children. But one of the studies by Harvard University researchers, of nearly 1,900 women with carefully documented immunization records, found no link between the vaccination and the development of the disease.

The second study, by French and Canadian researchers, found that a variety of vaccines, including those against hepatitis B, tetanus and influenza, did not cause the symptoms to worsen in patients who had already been diagnosed with MS.

From his base at Vanderbilt, Gellin directs the National Network for Immunization Information, a partnership of medical professional societies (Infectious Diseases Society of America, Pediatric Infectious Diseases Society, American Academy of Pediatrics and the American Nurses Association) that works in concert to improve the immunization dialogue. Schaffner and Dr. Kathryn M. Edwards, professor of Pediatrics, serve on the steering committee of the organization that seeks to provide the public, health professionals, policy makers and the media with up-to-date, scientifically valid information about immunizations to help them understand the issues and make informed decisions about immunizations.

“In many ways, the current immunization story is a case study of the doctor-patient relationship in the era of the information age,” Gellin said.

Gellin said that consumers who begin to question the safety and the continuing need for vaccines may not be getting the full picture when they don’t have the best information.

“When a theory comes out, it takes a long time and good science to come up with an answer. In the interim, people are left with a lot of questions,” Gellin said. “When an allegation is raised, you need good studies that are large enough to answer the questions definitively.”

A vaccine against hepatitis B has been available since the early 1980s. It can prevent infections in health care workers who accidentally stick themselves with contaminated needles. The vaccine has been recommended as a routine infant immunization in the U.S. since 1991 and for adolescents since 1995.

The French/Canadian study was initiated following case reports of individuals who developed MS and other central nervous system symptoms after having received the hepatitis B vaccine. Only rigorous epidemiological studies could provide a definitive answer to the question of cause and effect.

The findings of both studies are important for recipients of the hepatitis B vaccine, MS patients and their physicians, Gellin said. But careful scientific studies are not enough. A focused educational effort must take place and communication between patients and their doctors and nurses must be improved.

“The public’s understanding of immunizations is limited,” the authors wrote in the editorial. “A recent survey (that Gellin and his team published in the November 2000 Pediatrics) showed that 25 percent of parents believed that their child’s immune system could actually be weakened by too many immunizations. Nearly the same proportion of parents thought that their children were already getting more vaccines than was good for them.”