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Chiropractic Antivaccination Arguments
... Researchers since that time have continued to detect vaccination hesitancy among chiropractors [8]. However, two articles concluded that only a minority of the chiropractic profession, fueled by the writings of a handful of vocal opponents, holds extreme anti-vaccination views [9,10]. Surveys of students and practitioners have confirmed that a majority of the rank-and-file offer general support for vaccination and the provision of the full spectrum of risk-benefit information to patients [11][12][13]. ...
... Doubts about vaccination have centered on several arguments. First is a belief that vaccinations do not produce immunity or that they actually cause disease [4,[6][7][8][9][10]12]. Second are concerns about vaccine safety, side effects and adverse events, links to autism, and general interference with appropriate development of the immune or nervous systems [4,5,[7][8][9][10]21,22]. ...
... First is a belief that vaccinations do not produce immunity or that they actually cause disease [4,[6][7][8][9][10]12]. Second are concerns about vaccine safety, side effects and adverse events, links to autism, and general interference with appropriate development of the immune or nervous systems [4,5,[7][8][9][10]21,22]. A third argument emphasizes preference for infection-driven immunization as more permanent or less risky than vaccine-induced protection. ...
This study investigated provider-based complementary/alternative medicine use and its association with receipt of recommended vaccinations by children aged 1-2 years and with acquisition of vaccine-preventable disease by children aged 1-17 years. Results were based on logistic regression analysis of insurance claims for pediatric enrollees covered by two insurance companies in Washington State during 2000-2003. Primary exposures were use of chiropractic, naturopathy, acupuncture, or massage practitioner services by pediatric enrollees or members of their immediate families. Outcomes included receipt by children aged 1-2 years of four vaccine combinations (or their component vaccines) covering seven diseases, and acquisition of vaccine-preventable diseases by enrollees aged 1-17 years. Children were significantly less likely to receive each of the four recommended vaccinations if they saw a naturopathic physician. Children who saw chiropractors were significantly less likely to receive each of three of the recommended vaccinations. Children aged 1-17 years were significantly more likely to be diagnosed with a vaccine-preventable disease if they received naturopathic care. Use of provider-based complementary/alternative medicine by other family members was not independently associated with early childhood vaccination status or disease acquisition. Pediatric use of complementary/alternative medicine in Washington State was significantly associated with reduced adherence to recommended pediatric vaccination schedules and with acquisition of vaccine-preventable disease. Interventions enlisting the participation of complementary/alternative medicine providers in immunization awareness and promotional activities could improve adherence rates and assist in efforts to improve public health.
... Extremists in times of pandemics are not different from extremism in times of crises such as the financial crisis in 2008, which gave growth to left-wing and right-wing extremism, or the migration crisis in 2015, which has boosted right-wing extremists in particular (Bárd et al. 2020). Such crises were gateways for extremists worldwide, whose political business model consists of fomenting doubts about the ability of politicians and the media to act, react and legitimize, and mobilizing the concerns, fears and resentments of the population (Bárd et al. 2020;MIDEM 2021 (Busse et al. 2005;Ernst 2001). This negative attitude toward vaccinations is still taught and internalized in chiropractic education (Busse et al. 2005). ...
... Such crises were gateways for extremists worldwide, whose political business model consists of fomenting doubts about the ability of politicians and the media to act, react and legitimize, and mobilizing the concerns, fears and resentments of the population (Bárd et al. 2020;MIDEM 2021 (Busse et al. 2005;Ernst 2001). This negative attitude toward vaccinations is still taught and internalized in chiropractic education (Busse et al. 2005). Many medical and nonmedical naturopaths also oppose vaccination (Ernst 2001;von Ammon et al. 2012). ...
We present an overview of literature that relates to historical and modern anti-vaccination movements and associated socio-political conflicts. We show that the anti-vaccine movement against coronavirus disease is not unique, but that opposition to vaccination has existed as long as vaccination itself. We further detail critics of vaccination that has taken various position in different social groups, and address the roots and causes of the opposition from a global perspective. In the course of the work, it becomes clear that vaccination reservations are as varied as the people they serve and that the emotions and deep-rooted beliefs that underlie vaccine opposition have remained relatively consistent since the 18th century. Finally, we highlight the role of governments against opposition and propose micro-level (e.g., individual, health care providers) and macro-level (health care system, national) interventions. We conclude that despite all the social-political challenges, the role of government in vaccine management and promoting confidence in efficacy and safety through effective public health communication is critical.
... La chiropratique est une méthode mise au point à la fin du XIX e siècle par D.D. Palmer, qui a mis de l'avant une nouvelle théorie de la maladie centrée sur les lésions du système nerveux, qu'il appelait des subluxations. À l'origine, la théorie de la chiropratique découlait du principe voulant que la plupart, sinon la totalité des maladies étaient attribuables à des lésions ou à des dysfonctionnements des articulations (Busse, Morgan et Campbell, 2005). L'Association chiropratique canadienne (ACC) défend les intérêts professionnels des chiropraticiens canadiens. ...
... Campbell, Busse et Injeyan (2000), à l'instar de Busse, Morgan et Campbell (2005), ont cerné plusieurs arguments anti-vaccination qu'utilisent fréquemment les chiropraticiens : les vaccins sont inefficaces, puisque des maladies contagieuses apparaissent même dans les collectivités vaccinées et que leur diminution est attribuable à une amélioration des conditions de vie et de l'hygiène; la vaccination n'est pas nécessaire et peut même être dangereuse; on voit même dans les milieux médicaux une mésentente au sujet de l'utilité des vaccins, voire une contestation de la vaccination. Ce genre de discours se retrouve dans des articles de revues de chiropratique (non soumis à un comité de lecture), sur les sites Web de chiropraticiens et dans la publicité payante (Busse, Morgan et Campbell, 2005). ...
... its official origin can be associated with America and the appearance of osteopathy thanks to Andrew Taylor Still (1828-1917) and chiropractic, introduced almost at the same time by the Palmer family: father (1845-1913) and son [2][3][4]. ...
The beginnings of manual therapy in Poland, historically speaking, date back to the 1920s and 1930s and are associated with the names of Olgierd Krukowski and Michał Pawłowski, who published their textbooks related to the subject of chiropractic in 1926. The term ‘manual therapy’ appeared in Poland in the period after World War II. Professor Henryk Chmielewski, MD, PhD, bound with the academic centre in Lodz, is commonly regarded as the father of manual therapy in Poland. The aim of the article is to show the biography of Professor Henryk Chmielewski as a pioneer of contemporary manual therapy in Poland, as well as of several other figures who, through their scientific and journalistic achievements, made a significant contribution to the development of this field of medicine in the second half of the 20th century and at the beginning of the 21st century. The paper also presents the figure of Professor Karel Lewit from Prague, who played a very important role in the advancement of manual therapy throughout Europe. The article also includes a brief history of founding manual therapy societies and the quarterly Manual Medicine in Poland.
... Both the American Chiropractic Association and the International Chiropractic Association support individual exemptions to standard vaccinations (Campbell et al., 2000). The founder of chiropractic, Daniel Palmer, believed that vaccines were ineffective vials filled with "filthy animal poison" (Busse et al., 2005). In addition, a survey of practitioners of homeopathy indicated that 83% do not recommend vaccinations (Ernst, 2001). ...
Measles is a viral infection that has a characteristic pattern of prodromal symptoms followed by a rash. Previously considered an inevitable childhood condition, measles is known as the “first” classic childhood exanthem. For most children, measles was a one-time, short-term illness; however, some children developed complications that led to severe sequelae and death. The introduction of the measles vaccine dramatically decreased the number of cases, but the current trend against vaccination has caused outbreaks of the condition. We propose the implementation of the AAA approach (assume, advise, and answer) as a way for providers to directly encourage the administration of the vaccine and prevent future cases of measles.
... Parents were targeted because they will be making decisions about vaccination for their children, as well as for themselves. The "alternative" parents were included because it is known that alternative health care providers (e.g., homeopaths, naturopaths and chiropractors) tend to recommend that their patients refuse vaccinations [15][16][17] and this population could pose a threat to the public's health if they refuse to vaccinate themselves or their children during a pandemic. The "mainstream" parents serve as a control for the "alternative" parents and represent the majority of parents in the population. ...
Governments and health agencies worldwide are planning for a potential influenza pandemic. Their plans acknowledge the importance of public communication during an outbreak and include related guidelines and strategies. Emerging infectious disease (EID) communication is a new addition to the literature, drawing on health promotion communication, crisis communication and environmental/technological risk communication. This paper adds to the literature, exploring the notion of 'effective communication during health crises' by reporting on interviews with 22 public health officials, scientists and communications professionals responsible for communicating with the public. When analyzed in the context of the risk communication literature, the interviews reveal several considerations for health risk communicators. First, given the important role that mass media will play in an EID outbreak, there is an urgent need for public health to build partnerships with journalists based on an understanding of the two parties' unique societal roles. Second, seemingly practical communications considerations - such as how certain to be about information before sharing it and whether to engage in two-way communication with the public - have ethical dimensions that deserve attention. Third, there are unique challenges associated with communicating uncertainty, which would benefit from an exploration of the role of trust in health crisis communication.
... Parents were targeted because they would be making decisions regarding vaccination for their children, as well as for themselves. The 'alternative' parents were included because it is known that alternative healthcare providers (for example, homeopaths, naturopaths and chiropractors) tend to recommend that their patients refuse vaccinations, [15][16][17] and this population could pose a threat to the public's health if they refuse to vaccinate themselves or their children during a pandemic. The 'mainstream' parents served as a control for the 'alternative' parents and represented the majority of parents in the population. ...
As influenza H1N1 spreads around the world, health officials are considering the development and use of a new vaccine to protect the public and help control the outbreak. Acceptance of novel vaccines during health crises, however, is influenced by perceptions of a range of risks, including the risk of infection, risk of becoming severely ill or dying if infected, as well as the risk of serious side and long-term effects of the vaccine. A study on 11 focus groups was conducted with the public in Vancouver, Canada in 2006 and 2007 to explore how people assess these risks and how these assessments relate to their willingness to use novel vaccines in a pandemic. Concerns about using new vaccines during a pandemic differ from concerns about using established products in a non-crisis situation. Participants were hesitant to use novel vaccines because of a low perception of the early risk of infection in a pandemic, coupled with the many uncertainties that surround new vaccines and the emerging infectious disease, and owing to the concern that unsafe pharmaceuticals may be rushed to market during a health crisis. Understanding the public´s assessment of the risks related to, and willingness to use, novel vaccines during a pandemic can help officials promote disease-control measures in ways that improve the likelihood of acceptance by the public and may increase uptake of an H1N1 vaccine.
... After completion of the public health course, the younger, healthier students also demonstrated significant and more substantial positive changes in their attitudes about public health. Chiropractors and chiropractic users have historically been perceived as having "antivaccination" tendencies; however, evidence is accruing of changes over time in the personal and professional attitudes of chiropractors toward vaccination, [24][25][26][27][28][29][30] and more research should be directed toward better understanding vaccination attitudes and behaviors of all health care providers, 30 their patients, and the general public. More research is needed as well to better understand the challenges and implications of changing recommendations for preventive vaccinations, especially because the most recent CDC guidelines for seasonal influenza recommend that all US adults should be considered "high priority" for receiving vaccination. ...
Two recent studies that examined National Health Interview Survey data reported divergent findings regarding the propensity of adult chiropractic users to receive seasonal influenza immunization. Although one study found a statistically significant negative association between chiropractic use and influenza vaccination, another found that chiropractic users were significantly more likely to be vaccinated. The purpose of this study is to extend previous works by delving more deeply into recent data to identify adult chiropractic users at high risk and high priority for vaccination against influenza and pneumococcal disease.
We used data from the 2007 National Health Interview Survey in an attempt to replicate previous methodologies and further examine vaccination among adult chiropractic users (age ≥18 years) who, according to the Center for Disease Control and Prevention guidelines, should receive influenza and/or pneumococcal vaccination. We used complex survey design methods to make national estimates and used logistic regression to determine if having used chiropractic care predicted vaccination.
We found major methodological differences between the prior studies. In our analyses, we found that chiropractic users were significantly less likely than nonusers to have received the pneumococcal vaccine, and we found no significant difference between chiropractic users and nonusers relative to having received the seasonal flu vaccine.
Methodological differences in previous studies that investigated the association between chiropractic care and adult vaccination likely explain divergent findings reported in the literature. Future studies should consider these differences.
... Parents who attend CAM providers, including naturopathic physicians, may have a greater risk of exposure to anti-vaccination arguments [10,23]. Such arguments typically fall into 1 of 2 categories: vaccines are not effective and the risks of vaccination outweigh the benefits [24,25]. No vaccine is 100% safe or 100% effective, and this is true of any health care intervention. ...
Parents who choose to selectively vaccinate or avoid vaccination for their children may do so at risk of compromising relations with their family physician or pediatrician. Groups that are associated with reduced rates of pedicatic vaccination, such as parents who access naturopathic care, may be particularly vulnerable to this issue.
In March through September 2010, we administered a 26-item cross-sectional survey to 129 adult patients, all of whom were parents with children ≤ 16 years of age, presenting for naturopathic care in Ontario, Canada. Ninety-five parents completed the survey (response rate 74%), and only 50.5% (48 of 95) reported that their children had received all recommended vaccines. Most parents (50.5%; 48 of 95) reported feeling pressure to vaccinate from their allopathic physician and, of those who discussed vaccination with their physician, 25.9% (21 of 81) were less comfortable continuing care as a result. Five percent (4 of 81) of respondents were advised by their physician that their children would be refused care if they decided against vaccination. In our adjusted generalized linear model, feeling pressure to vaccinate (odds ratio [OR] = 3.07; 95% confidence interval [CI] = 1.14 to 8.26) or endorsing a naturopathic physician as their most trusted source of information regarding vaccination (OR = 3.57; 95% CI = 1.22 to 10.44) were associated with greater odds of having a partially vaccinated or unvaccinated child. The majority (69.6%; 32 of 46) of parent's with partially vaccinated or unvaccinated children reported a willingness to re-consider this decision.
Use of naturopathic care should be explored among parents in order to identify this high-risk group and engage them in discussion regarding pediatric vaccination to encourage evidence-based, shared decision making. Physicians should ensure that discussions regarding vaccination are respectful, even if parents are determined not to vaccinate their children.
... Parents were targeted because they will be making decisions about vaccine and drug use for their children, as well as for themselves. The "alternative" parents were included because it is known that alternative health care providers (e.g., homeopaths, naturopaths, and chiropractors) tend to recommend that their patients refuse vaccinations (Busse, Morgan, & Campbell, 2005;Ernst, 2002;Schmidt & Ernst, 2003) and this population could pose a threat to the public's health if they refuse to vaccinate themselves or their children during a pandemic. Thus, we felt it was necessary to gain insight into their decision-making process and understand the cause of their resistance and the information they are seeking. ...
To prepare for pandemics, countries are creating pandemic preparedness plans. These plans frequently include crisis communication strategies that recommend conducting pre-crisis audience research to increase the effectiveness and relevance of communication with the public. To begin understanding the communication needs of the public and health care workers, 11 focus groups were conducted in Vancouver, Canada, in 2006 and 2007 to identify what information people want to receive and how they want to receive it. In the event of a pandemic, participants want to know their risk of infection and how sick they could become if infected. To make decisions about using vaccines and drugs, they want information that enables them to assess the risks of using the products. The public prefers to receive this information from family doctors, the Internet, and schools. Health care workers prefer to receive information in e-mails and in-services.
... If we had one hundred cases of small-pox, I can prove to you where, in one, you will find a subluxation and you will find the same condition in the other ninety-nine. I adjust one and return his functions to normal and you could do the same with the other ninety-nine (23). Many of the sectarian schools-then and nowtaught didactic courses in chemistry, physiology, and pathology in the preclinical years, but lapsed into sectarian dogma once the student entered the clinic. ...
[Chiropractic] is grounded upon the doctrine that all human ills are caused by pressure of misplaced vertebrae upon the nerves which come out of the spinal cord—in other words, that every disease is the result of a pinch. This, plainly enough, is buncombe. The chiropractic therapeutics rest upon the doctrine that the way to get rid of such pinches is to climb upon a table and submit to a heroic pummeling by a retired piano‐mover (1). H. L. Mencken, 1924 First, every student of medicine must have three years' preliminary study in a university. Second, he must study medicine for four years, and then practice under the direction of a physician for a full year before beginning to practice himself… [nor] dare to treat the ailing, except such as have beforehand in our University of Salerno passed a public examination under a regular teacher of medicine and been given a certificate not only by our professors of medicine but by one of our civil officials… (2). Decree of Frederick II, King of the Two Sicilies, 1240 AD
... Most chiropractic articles on vaccination are published in non-peer-reviewed magazines, and most provide a negative slant. Many of the frequently voiced chiropractic anti-vaccination arguments do not hold up under scrutiny [32,33]; however, this does not inhibit their continued dissemination and these sources were, and possibly continue to be, a major influence in the anti-vaccination attitudes of some CMCC (and perhaps other CAM) students. ...
We have investigated the attitudes towards vaccination of undergraduate chiropractic and naturopathic students in the two major complementary and alternative medicine colleges in Canada. While the majority of the students were not averse to vaccination, we found in both colleges that anti-vaccination attitudes were more prevalent in the later years of the programs. Reasons for this are discussed, and we provide suggestions for strategies to address the situation.
How much does endorsement of complementary and alternative medicine (CAM) correlate with negative attitudes towards vaccines? One of the difficulties of analysing the relationship between attitudes to CAM and attitudes towards vaccines rests in the complexity of both. Which form of CAM endorsement is associated with what type of reticence towards vaccines? While the literature on the relationship between CAM and attitudes towards vaccines is growing, this question has not yet been explored. In this study we present the results of a survey conducted in July 2021 among a representative sample of the French mainland adult population (n = 3087). Using cluster analysis, we identified five profiles of CAM attitudes and found that even among the most pro-CAM group, very few respondents disagreed with the idea that CAM should only be used as a complement to conventional medicine. We then compared these CAM attitudes to vaccine attitudes. Attitudes to CAM had a distinct impact as well as a combined effect on attitudes to different vaccines and vaccines in general. However, we also found a) that attitudes to CAM provide a very limited explanation of vaccine hesitancy and b) that, among the hesitant, pro-CAM attitudes are often combined with other traits associated with vaccine hesitancy such as distrust of health agencies, radical political preferences and low income. Indeed, we found that both CAM endorsement and vaccine hesitancy are more prevalent among the socially disadvantaged. Drawing on these results, we argue that, to better understand the relationship between CAM and vaccine hesitancy, it is necessary to look at how both can reflect lack of access and recourse to mainstream medicine and distrust of public institutions.
Background:
Historically, some chiropractors have been critical of vaccination, and this has been the subject of recent media attention in Canada. We explored the association between media attention and public dissemination of vaccination information on Canadian chiropractors' websites.
Methods:
In 2016, we identified all Canadian chiropractors' websites that provided information on vaccination by extracting details from the regulatory college website for each province using the search engine on their "find a chiropractor" page. We assessed the quality of information using the Web Resource Rating Tool (scores range from 0% [worst] to 100% [best]), determined whether vaccination was portrayed in a positive, neutral or negative manner, and conducted thematic analysis of vaccination content. We revisited all identified websites in 2019 to explore for changes to posted vaccination material.
Results:
In July 2016, of 3733 chiropractic websites identified, 94 unique websites provided information on vaccination: 59 (63%) gave negative messaging, 19 (20%) were neutral and 16 (17%) were positive. The quality of vaccination content on the websites was generally poor, with a median Web Resource Rating Tool score of 19%. We identified 4 main themes: there are alternatives to vaccination, vaccines are harmful, evidence regarding vaccination and health policy regarding vaccination. From 2012 to 2016, there was 1 Canadian newspaper story concerning antivaccination statements by chiropractors, whereas 51 news articles were published on this topic between 2017 and 2019. In April 2019, 45 (48%) of the 94 websites we had identified in 2016 had removed all vaccination content or had been discontinued.
Interpretation:
In 2016, a minority of Canadian chiropractors provided vaccination information on their websites, the majority of which portrayed vaccination negatively. After substantial national media attention, about half of all vaccination material on chiropractors' websites was removed within several years.
Some have said that the Internet is an instrument of democracy. Taken literally, this statement is false. We have to add: it is an instrument of potential democracy. The motto of the Internet can be summarized in the words, paradoxical and politically incorrect, pronounced by Jesus: “Whoever has will be given more” (Matthew, XIII, 12). To navigate in the Internet, to distinguish the pearl from the sow’s ear, you already have to have had access to culture—an access which normally (and I speak from personal experience) is associated with social privilege. The Internet, which potentially could be an instrument that could attenuate cultural inequalities, in the immediate, exasperates them. Schools need the Internet, of course, but the Internet, to be used according to its potential (let’s say realistically one-millionth of its capacity), needs state schools that really teach.
Vaccine contains active components, adjuvants, stabilizers, preservatives, and trace components. Adverse reactions to vaccines are rarely reported. However, all of vaccine components may elicit adverse reaction including life-threatening event in susceptible individuals, therefore raising concerns regarding safety of vaccine still continue up to date. Hypersensitivity reaction to vaccines can be classified as allergic reaction to the vaccine component, pseudo-allergic reaction, and exacerbation of allergic diseases. Hypersensitivity reactions to vaccine components rarely occurred in the population-level, while severe hypersensitivity reaction such as anaphylaxis may be consequent result in susceptible individuals. Some of components such as ovalbumin, gelatin, yeast, and latex were considered as common causes of allergic reactions to the vaccine. However, the incidence or causes of vaccine related hypersensitivity reaction in Korea were not well known. The aims of this article are to review the literatures with hypersensitivity reactions related with vaccine components, to provide detailed information about major components of vaccines commonly used in Korea, and to provide the best way of vaccination in susceptible individuals.
Since 1990, the number of mandated vaccines has increased dramatically. Today, a fully vaccinated child will have received nearly three dozen vaccinations between birth and age six. Along with the increase in number has come a growing wave of concern among parents about the unintended side effects of vaccines. In Vaccine, Mark A. Largent explains the history of the debate and identifies issues that parents, pediatricians, politicians, and public health officials must address. Nearly 40% of American parents report that they delay or refuse a recommended vaccine for their children. Despite assurances from every mainstream scientific and medical institution, parents continue to be haunted by the question of whether vaccines cause autism. In response, health officials herald vaccines as both safe and vital to the public's health and put programs and regulations in place to encourage parents to follow the recommended vaccine schedule. For Largent, the vaccine-autism debate obscures a constellation of concerns held by many parents, including anxiety about the number of vaccines required (including some for diseases that children are unlikely ever to encounter), unhappiness about the rigorous schedule of vaccines during well-baby visits, and fear of potential side effects, some of them serious and even life-threatening. This book disentangles competing claims, opens the controversy for critical reflection, and provides recommendations for moving forward. © 2012 The Johns Hopkins University Press. All rights reserved.
This article describes the diagnostic criteria, etiology, prevalence and optimal management strategies available for children with autism, based on a review of the literature.
The purpose of this collaborative summary is to document current chiropractic involvement in the public health movement, reflect on social ecological levels of influence as a profession, and summarize the relationship of chiropractic to the current public health topics of: safety, health issues through the lifespan, and effective participation in community health issues. The questions that are addressed include: Is spinal manipulative therapy for neck and low-back pain a public health problem? What is the role of chiropractic care in prevention or reduction of musculoskeletal injuries in children? What ways can doctors of chiropractic stay updated on evidence-based information about vaccines and immunization throughout the lifespan? Can smoking cessation be a prevention strategy for back pain? Does chiropractic have relevance within the VA Health Care System for chronic pain and comorbid disorders? How can chiropractic use cognitive behavioral therapy to address chronic low back pain as a public health problem? What opportunities exist for doctors of chiropractic to more effectively serve the aging population? What is the role of ethics and the contribution of the chiropractic profession to public health? What public health roles can chiropractic interns perform for underserved communities in a collaborative environment? Can the chiropractic profession contribute to community health? What opportunities do doctors of chiropractic have to be involved in health care reform in the areas of prevention and public health? What role do citizen-doctors of chiropractic have in organizing community action on health-related matters? How can our future chiropractic graduates become socially responsible agents of change?
This survey was conducted to identify factors that may be associated with changes in knowledge and attitudes towards basic health promotion and public health concepts among chiropractic students enrolled in a course in community health.
Anonymous surveys were conducted of students before and after a second-year chiropractic college course in community health. Results were analyzed using percentages and Chi Square statistics as appropriate.
Students' knowledge of health promotion and public health concepts improved significantly by the end of the course. Students' attitudes towards these also improved, although to a lesser degree. Students indicated that they had a favorable impression of the importance of utilizing health promotion in practice and working with other public health professionals. However, vaccinations were still looked upon unfavorably by half of the students by the end of the course. Pre-class, a positive attitude towards public health concepts was associated with being female, older, Latino, having children, having a poorer perceived health status, conservative politically and religious. These differences tended to lessen by the end of the course.
A course in community health was successful in adding to students' knowledge and positive attitudes towards health promotion and public health. However, additional educational strategies are needed to ensure changes in future practice behavior, particularly in the area of vaccinations.
This study describes the prevalence and correlates of perceptions of Canadian doctors of chiropractic regarding the adequacy of their undergraduate (UG) and postgraduate (PG) educational preparation to counsel patients about immunization/vaccination and explores their preferences for continuing education (CE) in this area.
A cross-sectional population-based postal survey of Alberta chiropractors was conducted in the summer of 2002.
The response rate was 78.2%. Forty-five percent perceived that their formal UG chiropractic education prepared them adequately to counsel people on immunization compared with 64% who agreed that their self-directed PG education prepared them adequately. College of graduation was significantly associated with perceptions related to UG but not PG education. Those who felt prepared to counsel on immunization by UG education used different immunization information sources than those who felt prepared by PG or both UG and PG education. Use of specific sources and perception of preparedness to counsel on immunization were both associated with antivaccination behaviors. Those who felt prepared by PG or both UG and PG education were more likely to engage in antivaccination behavior than others. Most respondents indicated interest in CE on immunization.
The proportion of doctors of chiropractic who perceive themselves adequately prepared to counsel on immunization varies by type of education considered and is related to vaccination behavior. Many are interested in some form of CE related to immunization/vaccination.
Introduction
It has been suggested that people exposed to measles in utero may be at high risk of developing Crohn's disease in adulthood.1 2 Swedish investigators have reported an increased incidence of Crohn's disease in individuals born shortly after a measles epidemic,3 and they later described four pregnant women with measles, three of whose offspring developed Crohn's disease as adults.4
Subjects, methods, and results
To test this surprisingly strong association we conducted a record linkage study in Denmark. Hospital records from the Blegdamshospital (until 1976 the main hospital for treatment of infectious diseases in Copenhagen county) for 1915-66 were screened to identify pregnant women aged 15-43 years with measles. Their children were identified through the Copenhagen civil register (or church registers for those born before 1923) and linked through their civil registration system numbers with the national hospital discharge, cancer, and inflammatory bowel disease registries. Offspring who died before 31 December 1995 were identified through death certificates. For those with a gastrointestinal diagnosis, we contacted the patient's doctor for more information.
We identified 472 women aged 15 to 43 years who had been admitted with measles. Thirty three were pregnant: 11 developed measles during the first trimester, 9 during the second, 6 during the third, and 9 had exanthema less than 14 days after delivery. All but three women were identified in the civil registers. Four first trimester pregnancies were never registered and one child could not be found in any register.
Of the 26 offspring identified (including one set of twins), four died, one in infancy. The diagnoses of the other three, who died as adults, did not suggest inflammatory bowel disease (drug addiction, lung cancer, and heart disease). Among individuals still alive (median age 51.4 (36-79) years) none were registered as having Crohn's disease in either the inflammatory bowel disease register for Copenhagen or the national hospital discharge register. Three had gastrointestinal diagnoses: colon cancer 51 years ago at age 28, benign rectal neoplasm 8 years ago at age 44, and proctitis haemorrhagica 19 years ago at age 21. These patients’ general practitioners confirmed that none had developed inflammatory bowel disease.
Comment
We identified the offspring of 25 women who had had measles during pregnancy and found no association between exposure to measles and Crohn's disease. Based on a binomial distribution, the upper 95% confidence limit of our observed zero cases was 2.8 cases, which is far from the 18.8 cases expected (3/4 x 25 exposed) from the report by Ekbom et al.4
We are confident about the diagnoses made at the Blegdamshospital and the recording of the pregnancies. We cannot exclude the possibility that other women treated for measles at the hospital were in fact pregnant. However, all the records contained information on last day of menstruation and if one period was missed we considered the woman possibly pregnant; according to the civil registers none of these women gave birth.
Subjects exposed to measles in utero were followed long past the age in which Crohn's disease peaks (1). Even if they had developed Crohn's disease before 1977, when the discharge registry was established, Crohn's disease is a chronic disease which often results in admission so those affected would probably have appeared in the discharge register at some time after this date. Proctitis haemorrhagica and colon cancer could both be associated with ulcerative colitis, but the patients admitted several times to hospital were never treated for colitis or an associated problem.
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Follow up of subjects exposed to measles in utero. Each line represents subjects followed from birth until 1995 or death. The age interval 15-30 years (within which the incidence of inflammatory bowel disease peaks) is shown. Year that registers were established is also indicated (CR=cancer register, IBDR=inflammatory bowel disease register, CRS=civil registration system, NHDR=national hospital discharge register)
We have no clear explanation for the discrepancy between our results and those of Ekbom et al. However, our findings agree with those of Jones et al,5 who followed the offspring of 47 women with measles in pregnancy; none of their offspring developed Crohn's disease after an average follow up of 33 years. Measles infection in their study was self reported or diagnosed by a general practitioner and was presumably less severe than in our group of hospitalised women. In conclusion, exposure to measles in utero does not seem to be strongly associated with the development of Crohn's disease later in life.
Acknowledgments
We thank the staff at the registries, particularly those at the Copenhagen City Archives; Vibeke Binder at the Inflammatory Bowel Disease Register; Sonja Lerby at the Civil Registration System Register; and the staff at the Danish Cancer Registry.
Funding: P Carl Petersens Foundation and the Danish National Research Foundation.
Conflict of interest: None.
Notes
Contributors: The study design and protocol was formulated by PA, NMN, MM, and MS. MS, MJ, LLWN, and NMN screened the hospital records. LLWN, NMN, and MM conducted the linkage studies; together with PA, they also carried out the analysis. The paper was drafted by LLWN and NMN, and all the authors contributed to the final version. NMN is the guarantor.
References1.↵Wakefield AJ, Pittilo RM, Sim R, Cosby SL, Stephenson JR, Dhillon AP, et al. Evidence of persistent measles infection in Crohn's disease. J Med Virol 1993;39:345-3.OpenUrlMedlineWeb of Science2.↵Wakefield AJ, Ekbom A, Dhillon AP, Pittilo RM, Pounder RE. Crohn's disease: pathogenesis and persistent measles virus infection. Gastroenterology 1995;108:911-6.OpenUrlCrossRefMedlineWeb of Science3.↵Ekbom A, Wakefield AJ, Zack M, Adami HO. Perinatal measles infection and subsequent Crohn's disease. Lancet 1994;344;508-10.4.↵Ekbom A, Daszak PS, Kraaz W, Wakefield AJ. Crohn's disease after in-utero measles virus exposure. Lancet 1996;348:515-7.OpenUrlCrossRefMedlineWeb of Science5.↵Jones P, Fine P, Picacha S. Crohn's disease and measles. Lancet 1997;346:473.OpenUrl
A segment of chiropractic has historically opposed the practice of immunization. This opposition has been based on historical and philosophical precedent, but with little support from the scientific literature.
To identify a possible effect of pertussis vaccination in infancy on the risk for developing human IDDM.
A comparison was made of the cumulative incidence of IDDM in children age 0-12 years between two birth cohorts born before pertussis vaccination and two birth cohorts born after pertussis vaccination had been excluded from the Swedish national immunization program. The Swedish Childhood Diabetes registry was used to identify cases of IDDM. Yearly nurse reports on administered vaccines were used to determine coverage for diphtheria/tetanus/pertussis (DTP) and diphtheria/tetanus (DT) vaccines. Pertussis vaccine coverage was estimated based on number of doses of vaccine made available on license.
No difference in cumulative incidence rate of IDDM up to the age of 12 years was found when the birth cohorts for 1978 and 1979 with high DTP vaccination coverage were compared with the cohorts of 1980 and 1981 with low pertussis vaccination coverage.
The comparison of the cumulative incidence of IDDM, up to the age of 12 years, in birth cohorts with high and low exposure to pertussis vaccine does not support the hypothesis that pertussis could induce autoimmunity to the beta-cell that may lead to IDDM.
To describe the association between Bacille Calmette-Guérin (BCG) vaccination and IDDM development in two different case-control series (A and B) in Montreal.
Case-control series A comprised 93 IDDM cases and 2,903 control subjects who participated in a community-based tuberculin reactivity survey and who belonged to the same birth cohorts and areas of residence as the IDDM cases, Case-control series B comprised 249 IDDM cases and 431 age- and sex-matched friends and neighborhood control subjects.
In series A, the BCG vaccination prevalence among cases and control subjects was 21.5% (95% CI 13.2-29.8%) and 22.3% (95% CI 20.8-23.8%), respectively. The odds ratio (OR) for IDDM associated with BCG vaccination was 1.09 (95% CI 0.62-1.91), after adjusting for the birth cohorts and areas of residence. The vaccination prevalence in series B was 17.7% (95% CI 13.0-22.4%) among cases and 15.1% (95% CI 11.7-18.5%) among control subjects. The OR for IDDM due to BCG vaccination was 1.26 (95% CI 0.79-2.02), taking into account the matched sets. Only one case (3.3%) from series B who had been vaccinated at birth was diagnosed by age 5, compared with 52 cases (24.5%) who had not been vaccinated (P < 0.01).
The lower proportion of birth-vaccinated IDDM cases diagnosed at a very young age, compared with nonvaccinated cases, possibly reflects a temporary boost of the immune functions after vaccination. However, as a whole, results from these analyses fail to support a protective role of BCG vaccination against juvenile-onset IDDM.
To assess the impact of anti-vaccine movements that targeted pertussis whole-cell vaccines, we compared pertussis incidence in countries where high coverage with diphtheria-tetanus-pertussis vaccines (DTP) was maintained (Hungary, the former East Germany, Poland, and the USA) with countries where immunisation was disrupted by anti-vaccine movements (Sweden, Japan, UK, The Russian Federation, Ireland, Italy, the former West Germany, and Australia). Pertussis incidence was 10 to 100 times lower in countries where high vaccine coverage was maintained than in countries where immunisation programs were compromised by anti-vaccine movements. Comparisons of neighbouring countries with high and low vaccine coverage further underscore the efficacy of these vaccines. Given the safety and cost-effectiveness of whole-cell pertussis vaccines, our study shows that, far from being obsolete, these vaccines continue to have an important role in global immunisation.
To examine the relation between pertussis vaccination and the prevalence of wheezing illnesses in young children.
Prospective cohort study.
Three former health districts comprising Avon Health Authority.
9444 of 14 138 children enrolled in the Avon longitudinal study of pregnancy and childhood and for whom data on wheezing symptoms, vaccination status, and 15 environmental and biological variables were available.
Episodes of wheezing from birth to 6 months, 7-18 months, 19-30 months, and 31-42 months. These time periods were used to derive five categories of wheezing illness: early wheezing (not after 18 months); late onset wheezing (after 18 months); persistent wheezing (at every time period); recurrent wheezing (any combination of two or more episodes for each period); and intermittent wheezing (any combination of single episodes of reported wheezing). These categories were stratified according to parental self reported asthma or allergy.
Unadjusted comparisons of the defined wheezing illnesses in vaccinated and non-vaccinated children showed no significant association between pertussis vaccination and any of the wheezing outcomes regardless of stratification for parental asthma or allergy. Wheeze was more common in non-vaccinated children at 18 months, and there was a tendency for late onset wheezing to be associated with non-vaccination in children whose parents did not have asthma, but this was not significant. After adjustment for environmental and biological variables, logistic regression analyses showed no significant increased relative risk for any of the wheezing outcomes in vaccinated children: early wheezing (0.99, 95% confidence interval 0.80 to 1.23), late onset wheezing (0.85, 0.69 to 1.05), persistent wheezing (0.91, 0.47 to 1.79), recurrent wheezing (0.96, 0.72 to 1.26), and intermittent wheezing (1.06, 0.81 to 1.37).
No evidence was found that pertussis vaccination increases the risk of wheezing illnesses in young children. Further follow up of this population with objective measurement of allergy and bronchial responsiveness is planned to confirm these observations.
Throughout history, respiratory diseases have been a frequent cause of morbidity in U.S. populations. Because of stress, crowding, and naïve immune systems, military training populations are particularly prone to acute respiratory disease epidemics. An examination of the history of respiratory illness at the U.S. Naval Academy revealed that, in the earliest decades at the school, respiratory illness was a primary cause of both disease and mortality. With the advent of antibiotics and vaccines, most respiratory disease mortality has been reduced. However, even today, morbidity remains significant. Health concerns regarding respiratory diseases are heightened by emerging and reemerging respiratory disease agents that have increased antibiotic resistance and/or increased virulence. Enhanced surveillance and rapid diagnostic capabilities, placed in military settings, will increase knowledge of the epidemiology of many respiratory diseases. These strategies can lead to earlier treatment and prevention measures, thus halting the further transmission of disease and decreasing both morbidity and mortality. During the most recent history of the Naval Academy, acute respiratory infections have remained a primary cause of medical morbidity.
According to the polio model, severity of disease increases with age at infection. Firstborn children and people belonging to small families are generally infected later and should accordingly have a higher risk of severe polio. However, this model does contradict other explanations of severity of childhood infections including the intensive-exposure model.
To evaluate the deductions from the polio model we performed a study based on medical records from 5590 historical polio cases from the county of Copenhagen 1940-1953. The relative risk (RR) of polio according to age, birth order and sibship size was evaluated using census data from 1940 and 1950.
Severity of polio measured as frequency of paralysis or mortality did not show a steady increase with age, but a U-shaped curve being highest for the youngest as well as the oldest patients. The incidence of polio and paralytic polio was higher in families with several children compared with single children (RR = 1.13, 95% CI : 1.0-1.3). Furthermore, the incidence was higher in later-born children (P(trend) < 0.0001). However, as predicted from the intensive-exposure model, second-born children aged 1-4 years in two-child families had a higher risk of paralytic polio than first-born children (RR = 1.47, 95% CI : 1.1-2.0), whereas the opposite relationship was found for those aged > or = 5 years (RR = 0.65, 95% CI : 0.5-0.9).
The polio model's prediction about the impact of age, sibship size and birth order on polio incidence and severity found only limited support. A model emphasizing intensity of exposure as a risk factor for severity may account better for the epidemiology of polio infection.
Throughout history, respiratory diseases have been a frequent cause of morbidity in U.S. populations. Because of stress, crowding, and naive immune systems, military training populations are particularly prone to acute respiratory disease epidemics. An examination of the history of respiratory illness at the U.S. Naval Academy revealed that, in the earliest decades at the school, respiratory illness was a primary cause of both disease and mortality. With the advent of antibiotics and vaccines, most respiratory disease mortality has been reduced. However, even today, morbidity remains significant. Health concerns regarding respiratory diseases are heightened by emerging and reemerging respiratory disease agents that have increased antibiotic resistance and/or increased virulence. Enhanced surveillance and rapid diagnostic capabilities, placed in military settings, will increase knowledge of the epidemiology of many respiratory diseases. These strategies can lead to earlier treatment and prevention measures, thus halting the further transmission of disease and decreasing both morbidity and mortality. During the most recent history of the Naval Academy, acute respiratory infections have remained a primary cause of medical morbidity.
Many chiropractors treat patients with spinal adjustments based on the theory that correction of vertebral subluxations will restore and maintain health. This paper explores the controversy surrounding the practice of chiropractic and discusses some of the dangers associated with inappropriate use of spinal manipulation. Treatment of infants and children by subluxation-based chiropractors who do not endorse such medically accepted procedures as immunization or use of antibiotics is especially a cause for alarm. Explaining the scientifically rejected chiropractic subluxation therapy and describing some of the questionable treatment methods based on this theory, a veteran chiropractic reformer concludes that if the chiropractic profession fails to abandon the false premise upon which it is based, it will remain controversial and some aspects of chiropractic treatment will continue to be a threat to public health.
Several Internet Web sites opposing childhood immunizations are examined. Those sites that contain citations to scientific papers misrepresent their contents.
Pertussis (whooping cough) is an endemic and epidemic disease due to Bordetella pertussis. The disease has been and still is a major cause of morbidity and mortality in young children throughout the world. The World Health Organization estimates that 600,000 deaths due to pertussis occur yearly; virtually all of these deaths occurred in unimmunized infants.1 In the United States, pertussis has been successfully controlled by the routine mass immunization of infants and children. In the prevaccine era, there were 115,000 to 270,000 cases of pertussis and 5,000 to 10,000 deaths due to the disease each year.2 During the last 10 years, there have been 1,200 to 4,000 cases and five to ten deaths per year.3-6
Unfortunately, the control of pertussis by immunization has not enjoyed sustained international success because of controversy relating to vaccine reactions and effectiveness. Since 1982 this controversy has been a problem in the United States. Most pediatricians as well as a large number of parents are aware of the present pertussis vaccine controversy; however, few understand the facts. This controversy involving the media, political and legal sectors, and the scientific community is a major threat to our present immunization program and the future control of pertussis in the United States7-11 ("20/20," ABC News, Feb 5, 1985; "DPT: Vaccine Roulette," National Broadcasting Co, Date, 1982; Democrat and Chronicle, Rochester, NY, March 8-12, 1987, p 1; The Fresno Bee, Dec 2-3, 1984, p 1; Dec 5, 1987, p B14). Because of this, a task force on pertussis and pertussis vaccine was created by the Executive Board of the American Academy of Pediatrics to review the problem.
Since the introduction of acellular pertussis vaccines in Japan late in 1981, more than 20 million doses have been administered, mostly to children 2 years of age and older. Clinical studies indicate that mild local and febrile reactions are less frequent after administration of acellular pertussis vaccines than after whole-cell vaccines. Serious adverse events with sequelae occurred in 2-year-old children at approximately the same low rate during the period 1975 through August 1981, when whole-cell vaccines were used, and during August 1981 through 1984, when acellular vaccines were used exclusively. Five household contact studies have yielded vaccine efficacy estimates ranging from 78% to 92% in children 1 year of age or older. In addition, there has been a continuing decrease in reported pertussis incidence from the epidemic peak in 1979. Additional data on the safety and efficacy of acellular pertussis vaccines administered to infants would be useful in consideration of acellular pertussis vaccine licensure in the United States.
(JAMA 1987;257:1351-1356)
Objectives: To examine the relation between pertussis vaccination and the prevalence of wheezing illnesses in young children.
Design: Prospective cohort study.
Setting: Three former health districts comprising Avon Health Authority.
Subjects: 9444 of 14 138 children enrolled in the Avon longitudinal study of pregnancy and childhood and for whom data on wheezing symptoms, vaccination status, and 15 environmental and biological variables were available.
Main outcome measures: Episodes of wheezing from birth to 6 months, 7-18 months, 19-30 months, and 31-42 months. These time periods were used to derive five categories of wheezing illness: early wheezing (not after 18 months); late onset wheezing (after 18 months); persistent wheezing (at every time period); recurrent wheezing (any combination of two or more episodes for each period); and intermittent wheezing (any combination of single episodes of reported wheezing). These categories were stratified according to parental self reported asthma or allergy.
Results: Unadjusted comparisons of the defined wheezing illnesses in vaccinated and non-vaccinated children showed no significant association between pertussis vaccination and any of the wheezing outcomes regardless of stratification for parental asthma or allergy. Wheeze was more common in non-vaccinated children at 18 months, and there was a tendency for late onset wheezing to be associated with non-vaccination in children whose parents did not have asthma, but this was not significant. After adjustment for environmental and biological variables, logistic regression analyses showed no significant increased relative risk for any of the wheezing outcomes in vaccinated children: early wheezing (0.99, 95% confidence interval 0.80 to 1.23), late onset wheezing (0.85, 0.69 to 1.05), persistent wheezing (0.91, 0.47 to 1.79), recurrent wheezing (0.96, 0.72 to 1.26), and intermittent wheezing (1.06, 0.81 to 1.37).
Conclusions: No evidence was found that pertussis vaccination increases the risk of wheezing illnesses in young children. Further follow up of this population with objective measurement of allergy and bronchial responsiveness is planned to confirm these observations.
The publications of philosophically conservative chiropractors document their allegiance to a posture of hostile opposition to health prevention based upon immunization procedures. The challenge to medical anthropology is to make sense of what seems scientifically senseless. This paper attempts to come to an understanding of this position by tracing professional attitudes which are derived from a history of political and economic conflict with the American medical establishment, which emanate from an explanatory model of disease causation that preserves a nineteenth century monocausal theory, and which reflect a process of cultural schizmogenesis. In preserving these heretical medical beliefs, conservative chiropractors, who are trained in the basic medical sciences, defend themselves by basing their opposition to immunization upon imperfections in vaccines that relate to the efficacy, safety and necessity of immunizations. Further, they persist in a belief that chiropractic spinal manipulation provides an alternative method for achieving immune status. This belief has not been subjected to testing in clinical trials or laboratory experiments, and thus becomes a matter of belief rather than of scientific verity. A refusal to advocate or submit to vaccines serves conservative chiropractors as an understandable cultural symbol, but it is a symbol with sinister health costs to those who translate it into non-immune status in a world otherwise still hostage to disease-producing organisms.
To assess chiropractic attitudes toward immunization.
Random sample survey by mail.
One percent of American chiropractors were surveyed. The response rate was 37%.
Participants were asked to read APHA policy statement "7805: Immunization Against Childhood Diseases" before filling out the survey.
Five-point Likert scales of agreement and disagreement.
One-third agree that there is no scientific proof that immunization prevents disease, that vaccinations cause more disease than they prevent, and that contracting an infectious disease is safer than immunization. Eighty-one percent feel immunization should be voluntary and 46% support an official policy against the APHA resolution 7805. ICA members were more likely to agree with negative statements concerning immunization than ACA members.
There is a significant minority of American chiropractors who harbor anti-immunization sentiments despite the weight of scientific evidence supporting its value. Greater efforts must be made by chiropractic educators, associations, and licensing boards to ensure that clinicians base their attitudes on clinical and epidemiological research rather than emotion, rhetoric and dogma.
Caffeine abuse during pregnancy may be a factor in the development of long-term breathing abnormalities. Therefore, the objective of the present study was to monitor adult breathing patterns after in utero exposure to caffeine. This was done by isolating episodes of apnea of more than 6-s duration from the breathing data as obtained by the Cotwatch breathing monitors adapted for rat use. The breathing record obtained over 6 consecutive days was expressed as daily weighted apnea-hypopnea density (WAHD) values. It was shown that administration of caffeine in moderate (30 mg/kg daily) or high (60 mg/kg daily) doses throughout gestation resulted in a significant dose-dependent increase in the WAHD value. The experimental offspring were significantly growth retarded in utero and their subsequent growth rates were also affected. The caffeine-exposed pups grew more slowly with growth plateauing at the same age, resulting in smaller adults. A link was suggested between infants with apnea of prematurity, when occurring after the first week, and an increased risk for later apnea and sudden infant death syndrome.
The aetiology of Crohn's disease remains unknown, although evidence for a viral cause has long been sought. Recent studies have shown inflammation of the submucosal microvascular endothelium and granulomata, and endothelial cell cytoplasmic inclusions, consistent with paramyxovirus, were identified by electron microscopy suggesting a persistent measles virus infection in Crohn's disease. Measles, mumps, and rubella viruses were tested for Crohn's disease by polymerase chain reaction (PCR). RNA was extracted from resected intestinal specimens from 15 patients with Crohn's disease, 14 with ulcerative colitis, and 14 controls without inflammatory bowel disease. This was used to perform nested PCR after reverse transcription (RT) of the RNA to cDNA with primer pairs directed against two regions in the genome of the measles virus and one region in the mumps and rubella viral genomes. Despite enhanced sensitivity of nested RT-PCR, measles, mumps, and rubella viral genomic sequences were not found in any intestinal specimen.
The medical examination system in Japan covers only four regions (Yokohama, Osaka, Kobe and the 23 wards in Tokyo). In almost all other regions, it is difficult to perform reliable epidemiologic studies. This report presents a chronological analysis of sudden infant deaths, including sudden infant death syndrome, over 30 years (1964-93) in the 23 Tokyo wards.
We investigated a consecutive series of children with chronic enterocolitis and regressive developmental disorder.
12 children (mean age 6 years [range 3-10], 11 boys) were referred to a paediatric gastroenterology unit with a history of normal development followed by loss of acquired skills, including language, together with diarrhoea and abdominal pain. Children underwent gastroenterological, neurological, and developmental assessment and review of developmental records. Ileocolonoscopy and biopsy sampling, magnetic-resonance imaging (MRI), electroencephalography (EEG), and lumbar puncture were done under sedation. Barium follow-through radiography was done where possible. Biochemical, haematological, and immunological profiles were examined.
Onset of behavioural symptoms was associated, by the parents, with measles, mumps, and rubella vaccination in eight of the 12 children, with measles infection in one child, and otitis media in another. All 12 children had intestinal abnormalities, ranging from lymphoid nodular hyperplasia to aphthoid ulceration. Histology showed patchy chronic inflammation in the colon in 11 children and reactive ileal lymphoid hyperplasia in seven, but no granulomas. Behavioural disorders included autism (nine), disintegrative psychosis (one), and possible postviral or vaccinal encephalitis (two). There were no focal neurological abnormalities and MRI and EEG tests were normal. Abnormal laboratory results were significantly raised urinary methylmalonic acid compared with age-matched controls (p=0.003), low haemoglobin in four children, and a low serum IgA in four children.
We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers.
Pertussis vaccination in infancy has been suggested to increase the risk for development of asthma and allergy.
To assess sensitization rates and development of atopic diseases in a prospective randomized controlled trial of pertussis vaccine.
A total of 669 children were randomized to 1 of 4 vaccine groups (2-component acellular pertussis, 5-component acellular pertussis, whole-cell pertussis vaccines, and placebo [diphtheria and tetanus toxoids]). Diphtheria and tetanus toxoids were also given to the children in the pertussis vaccine groups. The children were evaluated by means of questionnaires at age 2 months, 7 months, and 2 1/2 years; skin prick tests at age 7 months and 2 1/2 years; and blinded clinical investigation at age 2 1/2 years. The families were contacted at regular intervals to assess possible adverse effects after the vaccinations and symptoms of whooping cough.
The cumulative incidence of atopic diseases was 30% and incidence rates were similar in the 4 groups after adjusting for family history. Exposure to environmental tobacco smoke and home dampness did not confound these results. The frequency of adverse effects did not differ appreciably between atopic and nonatopic children, with the exception that a nodule at the vaccination site was more frequent after whole-cell pertussis vaccination in the nonatopic children. Among 47 children with proven pertussis, atopic disease appeared in 19 (40%). Of these 47 children, 9 (19%) developed asthma, as compared with 58 (9%) noninfected children (P=.03).
We found no support for a drastic increase in allergic manifestations after pertussis vaccination. There was a positive association between whooping cough and asthma by 2 1/2 years of age. There seems to be little reason to withhold pertussis vaccination from infants, irrespective of family history of allergy.
We undertook an epidemiological study to investigate whether measles, mumps, and rubella (MMR) vaccine may be causally associated with autism.
Children with autism born since 1979 were identified from special needs/disability registers and special schools in eight North Thames health districts, UK. Information from clinical records was linked to immunisation data held on the child health computing system. We looked for evidence of a change in trend in incidence or age at diagnosis associated with the introduction of MMR vaccination to the UK in 1988. Clustering of onsets within defined postvaccination periods was investigated by the case-series method.
We identified 498 cases of autism (261 of core autism, 166 of atypical autism, and 71 of Asperger's syndrome). In 293 cases the diagnosis could be confirmed by the criteria of the International Classification of Diseases, tenth revision (ICD10: 214 [82%] core autism, 52 [31%] atypical autism, 27 [38%] Asperger's syndrome). There was a steady increase in cases by year of birth with no sudden "step-up" or change in the trend line after the introduction of MMR vaccination. There was no difference in age at diagnosis between the cases vaccinated before or after 18 months of age and those never vaccinated. There was no temporal association between onset of autism within 1 or 2 years after vaccination with MMR (relative incidence compared with control period 0.94 [95% CI 0.60-1.47] and 1.09 [0.79-1.52]). Developmental regression was not clustered in the months after vaccination (relative incidence within 2 months and 4 months after MMR vaccination 0.92 [0.38-2.21] and 1.00 [0.52-1.95]). No significant temporal clustering for age at onset of parental concern was seen for cases of core autism or atypical autism with the exception of a single interval within 6 months of MMR vaccination. This appeared to be an artifact related to the difficulty of defining precisely the onset of symptoms in this disorder.
Our analyses do not support a causal association between MMR vaccine and autism. If such an association occurs, it is so rare that it could not be identified in this large regional sample.
Backgroun dWe undertook an epidemiological study to investigate whether measles, mumps, and rubella (MMR) vaccine may be causally associated with autism. Method sChildren with autism born since 1979 were identified from special needs/disability registers and special schools in eight North Thames health districts, UK. Information from clinical records was linked to immunisation data held on the child health computing system. We looked for evidence of a change in trend in incidence or age at diagnosis associated with the introduction of MMR vaccination to the UK in 1988. Clustering of onsets within defined postvaccination periods was investigated by the case-series method. Finding sWe identified 498 cases of autism (261 of core autism, 166 of atypical autism, and 71 of Asperger's syndrome). In 293 cases the diagnosis could be confirmed by the criteria of the International Classification of Diseases, tenth revision (ICD10: 214 (82%) core autism, 52 (31%) atypical autism, 27 (38%) Asperger's syndrome). There was a steady increase in cases by year of birth with no sudden "step-up" or change in the trend line after the introduction of MMR vaccination. There was no difference in age at diagnosis between the cases vaccinated before or after 18 months of age and those never vaccinated. There was no temporal association between onset of autism within 1 or 2 years after vaccination with MMR (relative incidence compared with control period 0·94 (95% CI 0·60-1·47) and 1·09 (0·79-1·52)). Developmental regression was not clustered in the months after vaccination (relative incidence within 2 months and 4 months after MMR vaccination 0·92 (0·38-2·21) and 1·00 (0·52-1·95)). No significant temporal clustering for age at onset of parental concern was seen for cases of core autism or atypical autism with the exception of a single interval within 6 months of MM Rvaccination. This appeared to be an artifact related to the difficulty of defining precisely the onset of symptoms in this disorder. Interpretation Our analyses do not support a causal association between MMR vaccine and autism. If such an association occurs, it is so rare that it could not be identified in this large regional sample.
Findings from animal and human studies confirm that diphtheria and tetanus toxoids and pertussis (DTP) and tetanus vaccinations induce allergic responses; associations between childhood vaccinations and subsequent allergies have been reported recently.
The association of DTP or tetanus vaccination with allergies and allergy-related respiratory symptoms among children and adolescents in the United States was assessed.
Data were used from the Third National Health and Nutrition Examination Survey on infants aged 2 months through adolescents aged 16 years. DTP or tetanus vaccination, lifetime allergy history, and allergy symptoms in the past 12 months were based on parental or guardian recall. Logistic regression modeling was performed to estimate the effects of DTP or tetanus vaccination on each allergy.
The odds of having a history of asthma was twice as great among vaccinated subjects than among unvaccinated subjects (adjusted odds ratio, 2.00; 95% confidence interval, 0.59 to 6.74). The odds of having had any allergy-related respiratory symptom in the past 12 months was 63% greater among vaccinated subjects than unvaccinated subjects (adjusted odds ratio, 1.63; 95% confidence interval, 1.05 to 2.54). The associations between vaccination and subsequent allergies and symptoms were greatest among children aged 5 through 10 years.
DTP or tetanus vaccination appears to increase the risk of allergies and related respiratory symptoms in children and adolescents. Although it is unlikely that these results are entirely because of any sources of bias, the small number of unvaccinated subjects and the study design limit our ability to make firm causal inferences about the true magnitude of effect.
Although there is overwhelming evidence to show that vaccination is a highly effective method of controlling infectious diseases, a vocal element of the chiropractic profession maintains a strongly antivaccination bias. Reasons for this are examined. The basis seems to lie in early chiropractic philosophy, which, eschewing both the germ theory of infectious disease and vaccination, considered disease the result of spinal nerve dysfunction caused by misplaced (subluxated) vertebrae. Although rejected by medical science, this concept is still accepted by a minority of chiropractors. Although more progressive, evidence-based chiropractors have embraced the concept of vaccination, the rejection of it by conservative chiropractors continues to have a negative influence on both public acceptance of vaccination and acceptance of the chiropractic profession by orthodox medicine.
To describe the practice characteristics and pediatric care of chiropractors.
Cross-sectional, descriptive survey.
Chiropractic practices in the Boston, Mass, metropolitan area.
One hundred fifty licensed chiropractors.
Demographics, practice characteristics, and fee structure. Practitioners were also asked about their approach to childhood immunizations and a clinical scenario. Data were analyzed using simple descriptive statistics.
Ninety (60%) chiropractors responded. All were white and 65% were men. Respondents had on average 122 patient visits weekly, of which 13 (11%) were from children and adolescents. Typical visit frequency ranged from 1 to 3 times weekly. Average visit fees were 38 (initial and follow-up) and 49% of the fees were covered by insurance. Seventy percent of the respondents recommended herbs and dietary supplements. For pediatric care, 30% reported actively recommending childhood immunizations; presented with a hypothetical 2-week-old neonate with a fever, 17% would treat the patient themselves rather than immediately refer the patient to a doctor of medicine, doctor of osteopathy, or an emergency facility.
Children and adolescents constitute a substantial number of patients in chiropractics. An estimated 420000 pediatric chiropractic visits were made in the Boston metropolitan area in 1998, costing approximately $14 million. Pediatric chiropractic care is often inconsistent with recommended medical guidelines. National studies are needed to assess the safety, efficacy, and cost of chiropractic care for children.
The hypothesis that AIDS has its origins in a contaminated polio vaccine used in Africa in the late 1950s suffered a significant knock this week. Tests on samples of the vaccine, in storage for over 40 years, have shown no trace of HIV or its primate antecedent SIV.
The hypothesis that MMR vaccines cause autism was first raised by reports of cases in which developmental regression occurred soon after MMR vaccination. A previous study found no evidence to support this hypothesis. It has recently been suggested that MMR vaccine might cause autism, but that the induction interval need not be short. The data from the earlier study were reanalysed to test this second hypothesis. Our results do not support this hypothesis, and provide further evidence against a causal association between MMR vaccination and autism.
Although the Canadian Chiropractic Association and the Canadian Memorial Chiropractic College (CMCC) endorse vaccination, the prevalence of anti-vaccination attitudes among Canadian chiropractors is unknown. This study describes the prevalence of anti-vaccination attitudes among Canadian chiropractic students.
An 11-item questionnaire about attitudes toward vaccination was distributed to students enrolled at CMCC during the 1999/2000 academic year. The responses for the 11 items were then summed to arrive at a total score ranging from 0 (most negative attitude toward vaccination) to 22 (most positive attitude toward vaccination). Respondents' perceptions of sources of vaccine information were also investigated.
Over 75% of the students (467 of 621) completed the questionnaire. Most students (53.3%) reported that in general they agreed with vaccination. This was especially true among first-year students (60.7%). However, among fourth year students, only 39.5% agreed with vaccination. The proportion of respondents who stated that they were against vaccination in general was 5 (4.5%) of 112 first-year students, 10 (8.3%) of 121 second-year students, 16 (13.9%) of 115 third-year students and 35 (29.4%) of 119 fourth-year students. The mean scores on the questionnaire were progressively lower with each higher year of study at the College. The mean survey scores for each year of study were first year, 15.9 (95% confidence interval [CI] 15.2-16.6); second year, 16.1 (95% CI 15.3-1 7.0); third year, 14.5 (95% CI 13.5-15.4); and fourth year, 12.8 (95% CI 11.7-13.9). The mean scores varied among year of study and were statistically significant using one-way ANOVA (p < 0.0001). Among students who relied primarily on informal sources of vaccine information, such as the chiropractic literature and informal talks at CMCC, anti-vaccination attitudes were more prevalent in later years.
Most CMCC students reported pro-vaccination attitudes, but there appeared to be an increase in anti-vaccination attitudes as students progressed through the CMCC program. This pattern was seen almost exclusively among students who relied primarily on informal sources of vaccine information rather than on core CMCC lectures or prior lectures at university.
Pregnant rubella-susceptible women are often revaccinated during the postpartum period with the Measles, Mumps, and Rubella vaccine (MMR). It is known that the rubella virus from vaccine is secreted in breast milk and persists in the nose and throat for up to 28 days but it is not known whether the measles and mumps viruses are similarly secreted. It is probable the measles virus from vaccine is.
PIP
In theory, the Indian government's SWACH project uses an integrated approach to sanitation, water, and community health, but its priority is guinea worm control. It operates in 4 districts of Rajasthan. Ways to break the guinea worm cycle are converting step wells to draw wells, provision of hand pumps, teaching people to filter water before drinking it, and ayurvedic techniques to remove the guinea worm from the body before it breaks through the skin, at which point it becomes ineffective. Between 1986 and 1992, SWACH's efforts reduced the guinea worm cases 10-fold (from about 8000 to 800). In 1990 Sarsiya had 56 cases, but in 1992 it had none. SWACH has trained 70 local women to do handpump maintenance. It is in their interest to be handpump mechanics, since women collect the water. The village governments contract handpump repair out to these women. Each mechanic is responsible for handpump maintenance in about 10 villages. Even though the women complain that villagers do not know how to use handpumps, they do not teach then how to use the pumps. In fact, this reflects the project's lack of a broader approach to health education. SWACH's strength lies in the tangibles (e.g., handpumps and water filters). It has brought potable water to almost 1.5 million Indians. Most villagers are guinea worm specialists, but know little about other waterborne diseases and infectious diseases. SWACH does not monitor its effects on the prevalence of other waterborne diseases. SWACH staff also neglect community health. For example, a local midwife in the remote tribal village of Sarsiya was surprised to learn that she can prevent infection by boiling blades. She explained that SWACH field workers never informed her about the benefits of boiling. A man who once had guinea worm disease did not know how one gets it, yet SWACH staff treated him. Evaluations note the gap between project staff and villagers.
This article discusses the role of clean water in preventing fecal-oral transmission of infections, skin and eye diseases, water-based diseases, and insect vector diseases. Improvements to water quality are not sufficient to reduce infection. There is a need to educate people about appropriate hygiene and hand washing with soap and cleanliness of storage and eating utensils. Access to clean water is also important. Access to water reduces the household burden for women and children in time and effort. Households farthest from a supply of clean water would benefit the most from access to a clean water supply in time, effort, and money saved. The World Bank found that just the time saved in water collection was sufficient to justify house connections to a public supply of water. Most people would gladly pay for a water supply to be connected to their house. Free water at standpipes does not interfere with the demand for house connections. It was found that when water sources were shifted to locations closer than 1 km, the shift resulted in an increase in the amount of water used. When round-trip water collection takes about 30 minutes, level of use remains constant. When a water supply is moved to within a few yards of the house or piped indoors, use doubles or triples. Fecal contamination of water causes high rates of diarrheal disease, which kills over 3 million children per year. Diseases, such as cholera and typhoid fever, are transmitted through water-fecal links as well as contaminated food, fingers, utensils, and even clothes. More water available in the home would prevent women from using a corner of their sari to wipe dishes, wipe faces, and wipe a child's bottom. Large storage tanks do not prevent the presence of parasitic worms or insect vectors in the water supply.