Immunisation Safety Evidence: A Report for Healthcare Professionals

This report, prepared by a registered nurse, provides a comprehensive analysis of the evidence supporting the safety of immunisation, particularly focusing on the MMR vaccine. The report addresses parental concerns about the potential link between MMR and autism by reviewing meta-analyses, qu...Read More

Running head: EVIDENCE OF IMMUNISATION SAFETY
Evidence of immunisation safety
Name of the Student
Name of the University
Author note

1EVIDENCE OF IMMUNISATION SAFETY
Vaccination is the best method to protect children from vaccine-preventable diseases like
mumps, measles and whooping cough and serious illness. Through vaccination, parents not only
provide their children a healthy future, but also protect the community from spread of infectious
diseases (Bärnighausen et al. 2014). However, many parents refuse to get their children
immunised, as they fear of disease before immunisation. The parents believe that vaccination is
not beneficial for their children and without that, they are healthier as compared to vaccinated
children (Harmsen et al. 2013). While working as a registered nurse, it is my role to promote
immunisation for children like MMR (Measles, Mumps and Rubella) or other vaccinations.
Therefore, in the following section, I will provide information that immunisations are safe for
children based on current evidence so that parents are able to make right decisions for their
children.
Assessment template
Question 1
Question 1A
Do children who are immunized with MMR vaccine have better health outcomes as
compared to non-immunized population?
Question 1B
Source of information Type of information
Australian Government, Department of Health
website
The Australian Immunisation Handbook (2017)
Government of Western Australia Healthy information for Western Australia website
MMR Decision Aid A decision aid that provides information to parents

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and public whether to immunise their child with
MMR vaccine or not
Question 1C
Keyword Search term for Boolean ‘or”
vaccination Immunisation
Vaccination in children Vaccination and immunisation in children
MMR vaccine Benefits of MMR vaccine
Vaccine and autism Disadvantages of vaccine
Two combined doses of MMR Benefits of two doses over monovalent dose
Question 1D
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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Question 2
Table 1 : Meta-analysis (systematic review)
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.
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.
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.
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

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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.
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.
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
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.
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.
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.
Issue Health scares is a modern phenomenon that is

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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.
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.
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

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vaccines is done for economic reasons and viewed
it as dogmatic in response to concerns of parents.
Table 3 : Quantitative study
Full reference Prymula, R., Bergsaker, M.R., Esposito, S.,
Gothefors, L., Man, S., Snegova, N., Štefkovičova,
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.
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.
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

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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.
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.
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.
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)
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.
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.
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.
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

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is linked to ASD development.
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.
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.
Relevancy of above studies
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,

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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.