Vaccines and the Anti-Vaccination Movement: Important Context for Healthcare Providers

This article answers two important questions regarding vaccinations and healthcare providers:

How did the anti-vaccination movement originate in the United States and what do official sources say?
What vaccinations should healthcare workers receive to protect themselves, their families, and their patients?

History of the Anti-Vaccination Movement

In 1998, a study was published in the Lancet titled “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.” The study had a sample size of 12 children, could never be reproduced, and was funded by attorneys representing parents who were attempting to sue vaccine companies (Knopf). Even though the main researcher of the study lost his medical license in the aftermath of the study and the paper was retracted, there are countless individuals today who still believe vaccinations cause autism in children. Because of this, more and more children are not becoming immunized against diseases that were nearly non-existent a few years ago. Measles was considered eradicated in the United States in 2000, but more cases are occurring as more and more children are foregoing vaccinations.

Statements About Vaccines from Official Sources

Autism Speaks is the largest autism advocacy group in the nation. Rob Ring, the chief science officer, stated in 2015, “Over the last two decades, extensive research has asked whether there is any link between childhood vaccinations and autism. The results of this research are clear: Vaccines do not cause autism. We urge that all children be fully vaccinated” (Diament).

Also in 2015, the Centers for Disease Control and Prevention (CDC) released a reminder that there is no evidence connecting vaccines and autism, noting that a review by the Institute of Medicine (IOM) concluded that “the evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism” (Knopf).

Important Vaccinations for Healthcare Workers

Due to their occupation, healthcare workers are particular role players in nosocomial transmission and are at an increased risk of contracting diseases, including vaccine-preventable diseases (Hibberd). Healthcare providers should ensure that they are up to date with all recommended immunizations (Hibberd). The vaccines that healthcare workers should obtain are influenza, Hepatitis B, MMR, and the Tetanus, Diphtheria, and Pertussis vaccination (Immunization Action Coalition). The latest research and recommendations related to these vaccinations are listed below.

Influenza

It is recommended that all healthcare workers have an influenza vaccine annually (CDC). Through increased influenza vaccination of healthcare workers, studies have shown a marked decrease in the incidence of nosocomial respiratory illnesses (Haviari). A recent systematic review found that vaccination of healthcare workers significantly reduced influenza-like illness and all-cause mortality among patients (Ahmed).

Influenza is caused by a virus that mutates rapidly and, as a consequence, seasonal outbreaks occur annually, particularly during the winter (Haviari). For this reason, flu vaccines are adapted every year to best match the flu strains that are predicted to be circulating during that particular winter season (Haviari).

In addition to protecting themselves, healthcare professionals need to be vaccinated in order to protect their patients, especially those who are at an increased risk of severe complications associated with influenza including (NICD):

Pregnant women
HIV-infected individuals
Elderly patients (65 years and older)
People with chronic illnesses, such as diabetes, renal disease, heart disease, and lung disease
Children under 5 years of age
Obese people

Healthcare workers (and the general population) should receive the flu vaccine as soon as possible after the start of the flu season as the flu vaccine takes about 2 weeks to mount a proper antibody response (NICD). Influenza has a short incubation period (1 to 3 days), and it is still possible to contract flu if you are exposed within the 2-week period after flu vaccination (Haviari).

Hepatitis B Vaccine

All healthcare workers who may be exposed to blood or blood products as a result of their occupation are at risk of hepatitis B infection if they have not received previous complete vaccination or a blood test to confirm immunity to hepatitis B (WHO). The hepatitis B vaccine is 95% effective in preventing acute and chronic infection, thereby preventing the associated development of disease-related cirrhosis and liver failure (WHO). Healthcare professionals, particularly those who are frequently exposed to blood or blood products, are recommended to obtain anti-HBs (hepatitis B surface antigen) serologic testing 1 to 2 months after the third dose of hepatitis B vaccine in order to have documented evidence of immunity (IAC).

Measles, Mumps, and Rubella Vaccine (MMR)

Measles

Measles is caused by a virus and is one of the most highly transmissible diseases known to humankind and is also one of the deadliest vaccine-preventable diseases (Haviari). A term that has been used frequently since the COVD-19 pandemic is “herd immunity.” In order for herd immunity to be achieved, 92–95% vaccination coverage is required (Haviari). Healthcare workers are at a much greater risk of being exposed to measles than the general population (Steyn).

Mumps

Many countries have established vaccination programs where mumps vaccination is given in combination with measles and rubella vaccination even though it is not considered to be a disease for which healthcare workers are considered to be particularly vulnerable (WHO). All healthcare professionals working in medical facilities should be immune to measles and rubella (IAC).

Rubella

Although a mild viral disease in children, rubella is teratogenic, causing severe complications to the fetus if contracted by a pregnant woman, especially in the first trimester (Hibberd).

Tetanus, Diphtheria, Pertussis Vaccination

The Advisory Committee on Immunization Practices recommends a single dose of tetanus, diphtheria, and acellular pertussis (Tdap) vaccine for all adults, including pregnant women during each pregnancy, to protect themselves and reduce the risk for transmitting pertussis to infants too young to be vaccinated (Advisory Committee on Immunization Practices). To assure high Tdap coverage and disease prevention among healthcare personnel, patients, and others, the Advisory Committee on Immunization Practices recommends that healthcare employers provide Tdap vaccination to employees and use approaches that maximize vaccination rates (Advisory Committee on Immunization Practices).

Pertussis is a highly transmissible bacterial disease and is life-threatening to infants (Haviari). Although vaccination programs throughout the world have decreased the morbidity and mortality in children under 5 years of age, outbreaks still occur, even in countries with high vaccine coverage (CDC). Waning levels of immunity to pertussis in adolescents and adults have led to an increased prevalence of pertussis in the older population and subsequent transmission of pertussis to unimmunized and partially immunized infants (Chen).

Conclusion

Even though there are individuals who claim vaccinations are unhealthy and can cause a myriad of problems, they are still the reason many diseases have been reduced or nearly eradicated throughout the world. Healthcare workers are responsible for ensuring that they have protection and are up to date with all necessary vaccine-preventable diseases in order to protect themselves, their family members, and their patients (CDC).

References

Advisory Committee on Immunization Practices, CDC. Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2011;60(RR-7):1–45.
Ahmed F, Lindley MC, Allred N, Weinbaum CM, Grohskopf L. Effect of influenza vaccination of healthcare personnel on morbidity and mortality among patients: systematic review and grading of evidence. Clin Infect Dis. 2014;58:50–7.
Centers for Disease Control and Prevention (CDC). Recommended vaccines for healthcare workers. Updated 2 May 2016. Available from: https://www.cdc.gov/vaccines/adults/ rec-vac/hcw.html
Chen Z, He Q. Immune persistence after pertussis vaccination. Hum Vaccin Immunother. 13(4):744-756. doi: 10.1080/21645515.2016.1259780. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5404361/
Diament M. Autism speaks alters position on vaccines. Alaestra. 2015; 29(1). 55-56.
Haviari S, Bénet T, Saadatian-Elahi M, André P, Loulergue P, Vanhems P. Vaccination of healthcare workers: A review. Hum Vaccin Immunother. 2015 Nov; 11(11):2522-2537. doi:10.1080/21645515. 2015.1082014.
Hibberd P. Immunizations for health care providers. UpToDate. May 2019.
Immunization Action Coalition. Healthcare personnel vaccination recommendations. 2017. Available from: http://www.immunize. org/catg.d/p2017.pdf
Knopf A. Vaccines do not cause autism: Pediatricians fight back against anti-science. Brown University Child & Adolescent Behavior Letter. 2017.
National Institute for Communicable Diseases (NICD). Influenza Season 2019: Not Too Late For Vaccinate. 7 June 2019. Available from: http://www.nicd.ac.za/ influenza-season-not-too-late-to-vaccinate/
Steyn L. Vaccination recommendations for healthcare workers. Prof Nurs Today. 2019;23(3):20-22.
World Health Organization (WHO). Hepatitis B. 18 July 2018. Available from: https://www.who.int/ news-room/fact-sheets/detail/hepatitis-b

Dan Bunker DNAP, MSNA, CRNA—Dan has worked in the healthcare industry for nearly 30 years. He worked as a registered nurse in the coronary care ICU for 7 years and was a flight nurse with Intermountain’s Life Flight for nearly 10 years. He has been a certified registered nurse anesthetist (CRNA) for 11 years, working in the hospital setting as well as maintaining his own private practice. In addition, he is a professor in the nurse anesthesia program at Westminster College in Salt Lake City, Utah. He has served in various leadership roles within the Utah Association of Nurse Anesthetists (UANA) and is currently the president-elect.